Sex differences in the prevalence of Helicobacter pylori infection: an individual participant data pooled analysis (StoP Project)

Eur J Gastroenterol Hepatol. 2019 May;31(5):593-598. doi: 10.1097/MEG.0000000000001389.


Background: Helicobacter pylori (H. pylori) infection is more frequent among men, though the magnitude of the association might be inaccurate due to potential misclassification of lifetime infection and publication bias. Moreover, infection is common, and most studies are cross-sectional. Thus, prevalence ratios (PRs) may be easier to interpret than odds ratios (ORs).

Aim: The aim of this study was to quantify the association between sex and H. pylori infection using controls from 14 studies from the Stomach Cancer Pooling (StoP) Project.

Participants and methods: H. pylori infection was defined based on IgG serum antibody titers or multiplex serology. Participants were also classified as infected if gastric atrophy was present, based on histological examination or serum pepsinogen (PG) levels (PG I≤70 and PG I/II ratio≤3). Summary ORs and PRs, adjusted for age, social class and smoking, and corresponding 95% confidence intervals (CIs), were estimated through random-effects meta-analysis.

Results: Men had significantly higher OR (OR: 1.33, 95% CI: 1.04-1.70) and PR (PR: 1.05, 95% CI: 1.00-1.10) of infection, with stronger associations among hospital-based or older controls. Results were similar when considering the presence of gastric atrophy to define infection status, particularly among participants older than 65 years.

Conclusion: This collaborative pooled-analysis supports an independent effect of sex on the prevalence of H. pylori infection, while minimizing misclassification of lifetime infection status and publication bias.

Publication types

  • Meta-Analysis

MeSH terms

  • Aged
  • Antibodies, Bacterial / blood
  • Antibodies, Bacterial / immunology
  • Atrophy
  • Female
  • Gastritis, Atrophic / diagnosis
  • Gastritis, Atrophic / epidemiology
  • Gastritis, Atrophic / microbiology
  • Helicobacter Infections / diagnosis
  • Helicobacter Infections / epidemiology*
  • Helicobacter Infections / microbiology*
  • Helicobacter pylori / immunology
  • Helicobacter pylori / pathogenicity*
  • Humans
  • Immunoglobulin G / blood
  • Immunoglobulin G / immunology
  • Male
  • Middle Aged
  • Prevalence
  • Risk Assessment
  • Risk Factors
  • Serologic Tests
  • Sex Factors
  • Stomach / microbiology
  • Stomach / pathology


  • Antibodies, Bacterial
  • Immunoglobulin G