Effects of Helicobacter pylori Eradication on the Risk and Clinical Parameters of Metabolic Dysfunction‐Associated Steatotic Liver Disease: A Systematic Review and Meta‐Analysis

BACKGROUND: Previous studies have established an association between Helicobacter pylori (H. pylori) infection and metabolic dysfunction-associated steatotic liver disease (MASLD). However, the specific effects of H. pylori eradication therapy on MASLD patients remain unclear. Therefore, this systematic review and meta-analysis aims to comprehensively evaluate the impact of H. pylori eradication therapy on the incidence and clinical course of MASLD. MATERIALS AND METHODS: Cohort studies and randomized controlled trials (RCTs) were systematically retrieved from PubMed, Embase, Cochrane Library, and Web of Science. Hazard ratios (HRs) from cohort studies and mean differences (MDs) from RCTs with their corresponding 95% confidence intervals (CIs) were calculated to assess the impact of H. pylori eradication therapy on MASLD risk and changes in laboratory parameters. Subgroup analyses were performed based on varying follow-up periods and intervention type. Sensitivity analyses were conducted to assess the robustness of the findings. Funnel plots were used to evaluate publication bias. RESULTS: Eight studies, including two cohort studies assessing the incidence risk and six RCTs analyzing laboratory parameters, were included, encompassing a total of 5320 participants. All eligible studies were subjected to meta-analysis of their respective outcomes. H. pylori eradication therapy was found to significantly lower the risk of developing MASLD (HR = 0.74, 95% CI: 0.65-0.85). In patients already diagnosed with MASLD, eradication therapy was associated with reductions in waist circumference (MD = -0.62, 95% CI: -1.20 to -0.03), aspartate aminotransferase (AST; MD = -2.12, 95% CI: -2.78 to -1.45), fasting blood glucose (FBG; MD = -0.33, 95% CI: -0.66 to -0.01), homeostasis model assessment of insulin resistance (HOMA-IR; MD = -0.21, 95% CI: -0.25 to -0.17). CONCLUSIONS: The application of H. pylori eradication therapy correlates with a reduced risk of MASLD and favorable changes in anthropometric, hepatic, glycemic, and inflammatory outcomes, though these benefits may vary depending on the duration of follow-up and eradication methods.