Association between recurrent aphthous stomatitis and Helicobacter pylori infection: a meta-analysis

Several studies have shown the possible involvement of Helicobacter pylori infection in individuals with recurrent aphthous stomatitis (RAS), but the relationship remains controversial. This meta-analysis was performed to validate the association between RAS and H. pylori infection. The PubMed database was searched up to January 25, 2013 to select studies on the prevalence of H. pylori infection between RAS patients and control subjects. Studies were included if they evaluated and clearly defined exposure to RAS, reported the incidence of H. pylori infection, or provided data for their estimation. For subgroup analyses, studies were separated by region, publication year, and source of controls to screen the potential factors against the results. Before meta-analysis, the studies were evaluated for publication bias and heterogeneity. Summary odds ratio (OR) estimates with 95 % confidence intervals (CIs) were calculated using the fixed-effects model. Seven case-control studies containing 339 cases and 271 controls were eventually selected for analysis. A total of 100 (29.50 %) RAS patients had H. pylori infection, which was significantly greater than the 54 (19.93 %) non-RAS controls with H. pylori infection (OR = 1.85, 95 % CI: 1.24-2.74, P = 0.002). This result persisted in a hospital-based control subgroup (OR = 2.72, 95 % CI: 1.57-4.72). Based on our meta-analysis, H. pylori infection is associated with an increased risk of RAS. The eradication of H. pylori in the stomach may promote relief of RAS symptoms and healing of oral ulcers, and even prevent the occurrence of RAS.