Background
Methods
Literature search strategy and data extraction
Outcomes evaluated
Data synthesis
Research question | Explanatory data |
---|---|
Is H pylori infection associated with circulating ghrelin levels? | Data comparing circulating ghrelin concentration in H pylori positive and negative subjects |
What is the effect of eradicating H pylori on circulating ghrelin levels? | Data comparing the circulating ghrelin concentration before and after H pylori eradication |
What is the effect of H pylori infection on ghrelin expression in the stomach? | Data assessing any of the gastric ghrelin parameters |
Variable | Coding scheme |
---|---|
Study Team
| A, B, C etc |
Design
| Cohort, Cross-sectional, Case control, Experimental |
Healthy
| Healthy only, Sick only, Both |
Region
| Asia, Africa, Europe, North America, South America |
Gender
| Male only, Female only, Both |
Age
| Children only, Adults only, Both |
Number of methods used to assess
H pylori
| One method; two or more methods |
Type of ghrelin assay used
| Commercial RIA, in-house RIA, Commercial ELISA, Commercial EIA |
Sample storage
| -70°C and below; above -70°C |
Sample type
| Serum; Plasma |
Weight
| Normal, Low, Various, High |
Difference in circulating ghrelin concentration between
H pylori
+ & - subjects
| Lower, no difference, higher |
Changes in circulating ghrelin after cure
| Increased, decreased, no change |
Duration of follow-up
| 4 weeks & below; Above 4 weeks |
Sample size
| Two categorizations were done: 1) 50 & below, 51-200, 201 and above; 2)Above 20, Below 20 |
Statistical analysis
Meta-analysis
Results
Search results
Reason for exclusion | |
---|---|
Suzuki et al, 2006 [54] | Did not report ghrelin levels in H pylori positive &H pylori negative patients |
Nunes et al, 2006 [27] | Not sufficient information in abstract and authors could not be contacted for further clarifications |
Campana et al, 2007 [56] | All subjects were H pylori negative |
Isomoto et al, 2005 [52] | Compared only H pylori strains |
Checchi et al, 2007 [10] | Did not compare serum ghrelin levels in H pylori positive &H pylori negative subjects |
Wu et al, 2005[57] | Did not assess ghrelin |
Shinomiya et al, 2005[58] | Did not compare the difference in ghrelin between H pylori positive &H pylori negative subjects |
Suzuki et al, 2005[59] | Did not assess ghrelin |
Sundbom et al, 2007[60] | Did not assess H pylori
|
Huang et al, 2007[61] | Did not assess H pylori
|
Nishizawa et al, 2006[62] | Did not assess H pylori
|
Ando et al, 2006[63] | Did not assess ghrelin |
Kempa et al, 2007[64] | All subjects were H pylori negative |
Ates et al, 2008[65] | Did not assess H pylori
|
Wang et al, 2006[66] | Did not assess ghrelin |
Doki et al, 2006[67] | Did not assess H pylori
|
Gao et al, 2008[68] | Excluded people with H pylori
|
Cherian et al, 2009[69] | Did not assess ghrelin |
Kebapcilar et al, 2009[70] | Did not assess ghrelin |
Dutta et al, 2009[71] | Did not assess ghrelin |
Gen et al, 2010[72] | Did not assess ghrelin |
Taniaka-Shintani et al, 2005[1] | Examined only ghrelin immunoreactive cells |
Nwokolo et al, 2003[2] | Reported median values & 95% CI; also measured integrated ghrelin levels rather than the discrete measurement that other authors used. The authors stated that the median values were used because the sample size was small and the data were skewed |
Mendez-Sanchez et al, 2007 [49] | Studied ghrelin immuno-reactive cells, did not provide data on plasma ghrelin levels |
Salles et al, 2006[19] | Ghrelin values not provided. Only P-values |
Gao et al, 2009[15] | Ghrelin values not provided |
Choe et al, 2007[6] | Median & IQR provided. Further clarifications not provided by the authors |
Czesnikiewicz-Guzik et al, 2005[12] | Insufficient information for meta-analysis |
Czesnikiewicz-Guzik et al, 2007 [13] | Insufficient information for meta-analysis |
Masaoka et al [51] | This was a case study with only one subject |
Stec-Michalska et al, 2009[24] | Measured only gastric ghrelin |
Liew et al, 2006[47] | Assessed only gastric ghrelin |
Konturek et al, 2006[17] | The numbers of H pylori positive and negative participants were not provided and the authors did not respond to requests for further information. |
Is H pylori infection associated with circulating ghrelin levels?
Reference & Country | Study Team | Design | Healthy | Gender | Age | Method of H pylori assessment | Ghrelin assay kit | Overnight fast | Sample storage | Sample type | Weight | Sample size | Ghrelin levels in Hp+ vs Hp- |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Kawashima et al, 2009; Japan [38] | A | Cohort | Both | Both | Adults | Serology | Commercial EIA | Yes | -80 | Plasma | Normal | 220 | Lower |
Plonka et al, 2006; Poland [32] | B | Cohort | Healthy | Both | Both | Modified UBT plus ELISA | Commercial RIA | Yes | -80 | Serum | 538 | Lower | |
Isomoto et al, 2005; Japan[36] | C | Cohort | Sick | Both | Adults | RUT, histology (Giemsa stain) | In-house RIA | Yes | -80 | Plasma | Normal | 81 | Lower |
Roper et al, 2008; USA [18] | D | Cross-sectional | Healthy | Men | Adults | serology, histology & RUT or positive culture | Commercial EIA | Yes | -20 | Serum | Normal | 256 | No Difference |
Pacifico et al, 2008; Italy [26] | E | Cohort | Both | Both | Children | Culture of gastric specimen or histology + RUT | Commercial RIA | Yes | -70 | Serum | Normal | 85 | No Difference |
Gokcel, 2003; Turkey [3] | F | Case control | Sick | Women | Adults | Not stated | Commercial EIA | Yes | Not stated | Plasma | Normal | 39 | No Difference |
Plonka et al, 2006; Poland [43] | B | Case control | Healthy | Both | Children | Serology and UBT | Commercial RIA | Yes | -80 | Serum | Various | 287 | Lower |
Shiotani et al, 2005; Japan [21] | G | Case control | Healthy | Both | Adults | Detection of HP IgG ab in the urine | Commercial ELISA | Yes | Not stated | Serum | Various | 132 | Lower |
Osawa et al, 2005; Japan [40] | C | Case control | Sick | Men | Adults | Culture & histology | In-house RIA | Yes | -30 | Plasma | Normal | 160 | Lower |
Chuang et al*, 2009; Taiwan [30] | H | Cross-sectional | Sick | Men | Adults | Not described | Commercial RIA | Yes | -72 | Plasma | low to normal | 145 | Lower |
Chuang et al*, 2009; Taiwan [30] | H | Cross-sectional | Sick | Women | Adults | Not described | Commercial RIA | Yes | -72 | Plasma | low to normal | 196 | No Difference |
Alonso et al, 2007; Spain[42] | P | Cross-sectional | Sick | Both | Adults | UBT, histology (Giemsa stain) | Commercial RIA | Yes | -80 | Plasma | Normal | 15 | Lower |
Salles et al, 2006; France[19] | I | Cross-sectional | Sick | Both | Adults | UBT, serology, culture, histology & PCR | Commercial RIA | Yes | -80 | Plasma | low to normal | 62 | Lower |
Jun et al, 2007; Korea [37] | J | Cross-sectional | Sick | Both | Adults | RUT, histology (Giemsa stain) | Commercial RIA | Yes | -70 | Plasma | Normal | 63 | No Difference |
D'Onghia et al, 2007; Italy [31] | K | Case control | Both | Both | Adults | ELISA | RIA | Yes | -20 | Serum | Various | 79 | Lower |
Gao et al, 2009; China [15] | L | Case control | Healthy | Both | Adults | Serology & UBT. | Commercial RIA | Yes | -80 | Plasma | Normal | 100 | Lower |
Isomoto et al, 2005; Japan[35] | C | Cross-sectional | Sick | Both | Adults | Anti-IgG antibody, 13C-UBT, or RUT | In-house RIA | Yes | -80 | Plasma | Normal | 89 | Lower |
Isomoto et al, 2005; Japan[41] | C | Cross- sectional | Sick | Both | Adults | Serology, UBT or RUT | In-house RIA | Yes | -80 | Plasma | Normal | 249 | Lower |
An et al, 2007; Korea[33] | Q | Cohort | Sick | Both | Adults | Not stated | Commercial ELISA | Yes | -70 | Plasma | Normal | 41 | No difference |
Nishi et al, 2005; Japan [39] | C | Cross-sectional | Both | Both | Adults | Serology & UBT | In-house RIA | Yes | -80 | Plasma | Normal | 74 | Lower |
Czesnikiewicz-Guzik et al, 2005; Poland [12] | B | Cross-sectional | Healthy | Women | Adults | UBT | Not stated | Not stated | Not stated | Serum | Not Stated | 100 | Lower |
Konturek et al, 2006; Poland [17] | B | Cross-sectional | Healthy | Both | Both | UBT & serology | Human RIA | Yes | -80 | Serum | Not Stated | 180 | Lower |
Cindoruk et al, 2007; Turkey [11] | M | Cohort | Sick | Both | Adults | Either histology or UBT | RIA | Yes | -80 | Plasma | Normal | 50 | No Difference |
Isomoto et al, 2004; Japan [34] | C | Cohort | Sick | Both | Adults | Serology | Commercial RIA | Yes | -80 | Plasma | Normal | 68 | Lower |
de Martel, 2007; USA [14] | N | Case control | Sick | Both | Adults | In-house ELISA | Commercial ELISA | Yes | -80 | Serum | Various | 110 | No Difference |
Shak et al, 2008, USA[45] | R | Cohort | Healthy | Both | Adults | Serology | Commercial EIA | Yes | -20 | Plasma | Obese | 24 | No difference |
Uzzan et al, 2007[44] | S | Cohort | Healthy | Both | Adults | Histology | Commercial RIA | Yes | Not stated | Serum | Obese | 13 | No difference |
Characteristic | n | n % | |
---|---|---|---|
Study Design | Case control | 7 | 25.93 |
Cohort | 9 | 33.33 | |
Cross-sectional | 11 | 40.74 | |
Gender studied | Both | 21 | 77.78 |
Men | 3 | 11.11 | |
Women | 3 | 11.11 | |
Region | Asia | 13 | 48.15 |
Europe | 11 | 40.74 | |
North America | 3 | 11.11 | |
Health status | Both | 4 | 14.81 |
Healthy | 9 | 33.33 | |
Sick | 14 | 51.85 | |
Age Group | Adults | 23 | 85.19 |
Both | 2 | 7.41 | |
Children | 2 | 7.41 | |
Type of Sickness | Cancer | 3 | 17.65 |
GI symptoms | 11 | 64.71 | |
Others† | 3 | 17.64 | |
HP assessment methods used | Not Described | 5 | 18.52 |
One | 7 | 25.93 | |
Two or more | 15 | 55.56 | |
Assay Type | Commercial EIA | 4 | 14.81 |
Commercial ELISA | 3 | 11.11 | |
Commercial RIA | 14 | 51.85 | |
In-house RIA | 5 | 18.52 | |
Not stated | 1 | 3.7 | |
Sample Size | 50 and below | 6 | 22.22 |
51-200 | 16 | 59.26 | |
201 and above | 5 | 18.52 | |
Sample Storage | -70C and above | 19 | 70.37 |
Below -70C | 4 | 14.81 | |
Not Described | 4 | 14.81 | |
Sample type | Plasma | 17 | 62.96 |
Serum | 10 | 37.04 | |
BMI of participants | Normal | 15 | 57.69 |
Not Stated | 2 | 7.69 | |
Obese | 2 | 7.69 | |
Various | 4 | 15.38 | |
low to normal | 3 | 11.54 |
Meta-analysis
Studies excluded | SMD (95%CI) | Test for overall effect |
---|---|---|
Alonso et al, 2007 | -0.47 [-0.59, -0.35] | Z = 7.80 (P < 0.00001) |
An et al, 2007 | -0.49 [-0.61, -0.37] | Z = 7.88 (P < 0.00001) |
Chuang et al_male, 2009 | -0.48 [-0.61, -0.35] | Z = 7.39 (P < 0.00001) |
Cindoruk et al, 2007 | -0.49 [-0.61, -0.38] | Z = 8.48 (P < 0.00001) |
D'Onghia et al_case, 2007 | -0.47 [-0.60, -0.35] | Z = 7.64 (P < 0.00001) |
D'Onghia et al_control, 2007 | -0.49 [-0.61, -0.37] | Z = 7.95 (P < 0.00001) |
Gokcel et al, 2003 | -0.49 [-0.61, -0.36] | Z = 7.84 (P < 0.00001) |
Isomoto et al, 2004 | -0.46 [-0.57, -0.35] | Z = 7.96 (P < 0.00001) |
Isomoto et al, 2005a | -0.47 [-0.60, -0.35] | Z = 7.47 (P < 0.00001) |
Isomoto et al, 2005b | -0.47 [-0.59, -0.34] | Z = 7.43 (P < 0.00001) |
Isomoto et al, 2005c | -0.48 [-0.61, -0.35] | Z = 7.14 (P < 0.00001) |
Jun et al, 2007 | -0.49 [-0.61, -0.36] | Z = 7.72 (P < 0.00001) |
Kawashima et al, 2009 | -0.48 [-0.61, -0.35] | Z = 7.32 (P < 0.00001) |
Nishi et al, 2005 | -0.49 [-0.59, -0.39] | Z = 9.72 (P < 0.00001) |
Osawa et al, 2005 | -0.46 [-0.58, -0.34] | Z = 7.45 (P < 0.00001) |
Plonka et al_ch1 2006 | -0.46 [-0.58, -0.34] | Z = 7.65 (P < 0.00001) |
Roper et al, 2008 | -0.51 [-0.63, -0.39] | Z = 8.37 (P < 0.00001) |
Shak et al, 2008 | -0.48 [-0.60, -0.36] | Z = 7.79 (P < 0.00001) |
Shiotani et al, 2005 | -0.46 [-0.59, -0.34] | Z = 7.33 (P < 0.00001) |
Uzzan et al, 2007 | -0.47 [-0.59, -0.35] | Z = 7.76 (P < 0.00001) |
What is the effect of eradicating H pylori on circulating ghrelin levels?
Reference & Country | Study Team | Design | Healthy | Gender | Age category | HP assess | Ghrelin assay Kit | Sample storage | Sample type | Weight | Sample size | Circulating Ghrelin levels after cure | Follow-up (wks) |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Nwokolo et al, 2003; UK [2] | A | Cohort | Healthy | Both | Adults | Serology and UBT | Commercial RIA | -20 | Plasma | Various | 10 | Increased | 6 |
Jang et al, 2008; Korea [16] | B | Cohort | Sick | Both | Adults | RUT plus histology & confirmed by UBT | Commercial RIA | -70 | Plasma | Normal | 16 | Increased | Not stated |
Osawa et al, 2006; Japan [46] | C | Cohort | Healthy | Men | Adults | Bacterial culture & histology | In-house RIA | Not stated | Plasma | Normal | 134 | Decreased | 12 |
Czesnikiewicz-Guzik et al, 2007; Poland [13] | D | Cohort | Sick | Women | Adults | UBT; culture of saliva & supragingival dental plaques + serology | Commercial RIA | -80 | Plasma | Not stated | 49 | Increased | 4 |
Lee et al, 2010; Korea [23] | B | RCT | Healthy | Both | Adults | RUT, histology (Giemsa stain) | ELISA | -70 | Plasma | Normal | 9 | No difference | 5 |
Choe et al, 2007, Korea [6] | E | Cohort | Sick | Both | Adults | histology & PCR | Commercial ELISA | -70 | Plasma | Normal | 8 | No difference | 4 |
Pacifico et al, 2008; Italy [26] | F | Cohort | Both | Both | Children | Culture of gastric specimen or histology + RUT | RIA | -70 | Serum | Normal | 22 | Decreased | 52 |
Nweneka, et al, unpublished; Gambia | G | Cohort | Sick | Both | Children | UBT | Commercial RIA | -70 | Serum | Low | 3 | Decreased | 4 |
Isomoto et al, 2005; Japan [36] | C | Cohort | Sick | Both | Adults | RUT, histology (Giemsa stain) | In-house RIA | -80 | Plasma | Normal | 43 | No difference | 4 |
Isomoto et al, 2005; Japan[35] | C | Cohort | Sick | Both | Adults | RUT, histology (Giemsa stain) | In-house RIA | -80 | Plasma | Normal | 10 | No difference | 4 |
Kawashima et al, 2009; Japan [38] | H | Cohort | Both | Both | Adults | Serology | Commercial EIA | -80 | Plasma | Normal | 49 | Increased | 23 |
Cindoruk et al, 2007; Turkey [11] | I | Cohort | Sick | Both | Adults | Either histology or UBT | RIA | -80 | Plasma | Normal | 23 | No difference | 12 |
Isomoto et al, 2004; Japan [34] | C | Cohort | Sick | Both | Adults | Serology | Commercial RIA | -80 | Plasma | Normal | 9 | No difference | 4 |
Characteristic | n | % | |
---|---|---|---|
Study Design | Cohort | 12 | 92.31 |
RCT | 1 | 7.69 | |
Gender studied | Both | 11 | 84.62 |
Men | 1 | 7.69 | |
Women | 1 | 7.69 | |
Region | Africa | 1 | 7.69 |
Asia | 8 | 61.54 | |
Europe | 4 | 30.77 | |
Health status | Both | 2 | 15.38 |
Healthy | 3 | 23.08 | |
Sick | 8 | 61.54 | |
Age Group | Adults | 11 | 84.62 |
Children | 2 | 15.38 | |
Type of Sickness | GI Symptoms | 9 | 90 |
PEM | 1 | 10 | |
HP assessment methods used | One | 3 | 23.08 |
Two or more | 10 | 76.92 | |
Assay Type | ELISA | 2 | 15.38 |
Commercial RIA | 8 | 61.54 | |
In-house RIA | 3 | 23.08 | |
Sample Size | Above 20 | 6 | 46.15 |
Below 20 | 7 | 53.85 | |
Sample Storage | -70°C and below | 11 | 84.62 |
Above -70°C | 1 | 7.69 | |
Not described | 1 | 7.69 | |
Sample type | Plasma | 11 | 84.62 |
Serum | 2 | 15.38 | |
BMI of participants | Normal | 10 | 76.92 |
Others | 3 | 23.07 | |
Duration of follow-up | 4 weeks & below | 6 | 46.15 |
Above 4 weeks | 6 | 46.15 | |
Not recorded | 1 | 7.69 | |
Change in ghrelin after cure | Decreased | 3 | 23.08 |
Increased | 3 | 23.08 | |
No difference | 7 | 53.85 |