Impact of Helicobacter pylori Eradication on Clinical and Laboratory Parameters in Non-alcoholic Fatty Liver Disease Patients: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Objective: Helicobacter pylori (HP) infection is associated with non-alcoholic fatty liver disease (NAFLD) and insulin resistance; however, the correlation between HP eradication and NAFLD remains controversial. This systematic review and meta-analysis examined the effect of HP treatment on clinical and laboratory parameters in NAFLD patients.

Methods: We conducted a literature search of the PubMed, Embase, Scopus, and Web of Science databases through September 2023 for randomized controlled trials (RCTs) examining the effect of HP treatment on NAFLD patients versus lifestyle changes alone. The primary outcome was the change in steatosis parameters. The secondary endpoints were changes in anthropometric parameters, inflammatory markers (TNF-α), and metabolic parameters (fasting blood glucose, homeostasis model assessment of insulin resistance, AST/ALT, and lipid profile). The random effects model was used to calculate the standardized mean difference (SMD) with associated 95% confidence intervals (CIs) for our desired outcome.

Results: Four RCTs met our inclusion criteria. A total of 453 patients were included (mean age 42.8 years, 58.5% males), 228 (50.3%) of whom were in the HP eradication group and 225 (49.7%) of whom were in the lifestyle modification group. Compared with lifestyle modification alone, HP eradication had a significant effect on reducing liver steatosis and TNF-α levels (SMD: - 0.9; 95% CI - 14.67, - 3.82, I = 0% and SMD: - 6.3; 95% CI - 9.04, - 3.56, I = 0%, respectively). No significant effect on other metabolic parameters was found.

Conclusions: HP eradication significantly reduced liver steatosis and TNF-α levels in NAFLD patients. However, HP eradication did not significantly affect other metabolic indices compared to lifestyle changes alone.