The Controversies in the Relationship Between <i>Helicobacter pylori</i> Infection and Inflammatory Bowel Disease: Narrative Review.

Abstract

<b>Background</b><b>/</b><b>Objective</b><b>:</b> The relationship between <i>Helicobacter pylori</i> (<i>H. pylori</i>) infection and inflammatory bowel disease (IBD) remains controversial. While <i>H. pylori</i> is a well-established pathogen in gastroduodenal diseases, emerging evidence suggests it may exert immunomodulatory effects that influence the pathogenesis and clinical course of IBD. This review aims to explore the association between <i>H. pylori</i> infection and IBD, focusing on infection prevalence among IBD patients, the potential protective or harmful roles of <i>H. pylori</i>, and the impact of eradication therapy on IBD onset and activity. <b>Methods</b><b>:</b> A comprehensive literature search was conducted using PubMed up to, including clinical studies, meta-analyses, systematic reviews, and observational data. A total of 40 studies met the inclusion criteria and were critically reviewed. <b>Results:</b> The majority of studies indicate a significantly lower prevalence of <i>H. pylori</i> infection among patients with IBD compared to the general population. Several meta-analyses support a potential protective effect, particularly in Crohn's disease and among CagA-positive <i>H. pylori</i> strains. However, data on the impact of eradication therapy on IBD progression remain inconclusive. Some studies suggest a higher relapse risk post-eradication, while others report no change in disease activity. Variability in outcomes may be influenced by geographic, demographic, and methodological differences, as well as disease activity at the time of eradication. <b>Conclusions:</b> Although numerous studies support an inverse association between <i>H. pylori</i> infection and IBD, the nature and direction of this relationship remain unclear. Given the complex interplay between host immunity, gut microbiota, and antibiotic exposure, the decision to eradicate <i>H. pylori</i> in IBD patients should be individualized. Further prospective studies are needed to clarify the immunological and microbiological mechanisms underlying this association and to inform clinical guidelines.