Association between Helicobacter pylori, reflux and chronic rhinosinusitis: a systematic review.

Feb 03, 2025

Experts: Jerome R Lechien,Kamal Ragrag,Jason Kasongo,Valentin Favier,Miguel Mayo-Yanez,Carlos M Chiesa-Estomba,Giannicola Iannella,Giovanni Cammaroto,Alberto M Saibene,Luigi A Vaira,Florent Carsuzaa,Kalamkas Sagandykova,Maxime Fieux,Quentin Lisan,Stephane Hans,Antonino Maniaci

The prevalence, role, and clinical relevance of Helicobacter Pylori (HP) in sinonasal tissues of patients with chronic rhinosinusitis remain unclear.
To investigate the prevalence and clinical relevance of Helicobacter Pylori (HP) in chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP) and without nasal polyps (CRSSNP).
Three investigators conducted a PubMed, Scopus, and Cochrane Library systematic review of the prevalence and clinical relevance of HP infection in CRS patients through the PRISMA framework. A bias analysis was conducted to identify potential heterogeneity and biases across studies.
Of the 42 identified studies, 20 met the inclusion criteria, accounting for 741 CRS patients and 368 controls. HP was detected in 37.1% (n = 127/342) of polyps of CRSwNP patients with the polymerase chain reaction (PCR) and 32.7% (n = 37/113) of polyp tissue with the immunohistochemistry (IHC). Controls reported a nasal PCR and IHC detection rates of 14.8% (n = 36/243) and 3.6% (n = 3/84), respectively. The HP rate did not differ between CRSwNP and CRSsNP. Among patients with CRS, the enzyme-linked immunosorbent assay testing detected blood HP antigens in 48.7% (n = 74/152) of CRS patients and 41.6% (n = 37/89) of controls. The detection of HP in polyps was associated with the severity of gastroesophageal reflux disease (GERD). There was an important heterogeneity between studies for the inclusion criteria, methods of HP detection, and reflux outcomes.
Helicobacter Pylori can be detected in one-third of sinonasal tissues from patients with CRS and can be considered a biomarker of GERD. The potential role of HP in the development of CRS remains unclear. The heterogeneity between studies limits the drawing of valid conclusions.

© 2025. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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ABOUT THE EXPERTS

Jerome R Lechien,Kamal Ragrag,Jason Kasongo,Valentin Favier,Miguel Mayo-Yanez,Carlos M Chiesa-Estomba,Giannicola Iannella,Giovanni Cammaroto,Alberto M Saibene,Luigi A Vaira,Florent Carsuzaa,Kalamkas Sagandykova,Maxime Fieux,Quentin Lisan,Stephane Hans,Antonino Maniaci

Jerome R Lechien

Department of Surgery, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium. Jerome.Lechien@umons.ac.be.

Department of Otolaryngology-Head Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France. Jerome.Lechien@umons.ac.be.

Research Committee, Young Otolaryngologists of the International Federation of Otorhinolaryngological Societies, Paris, France. Jerome.Lechien@umons.ac.be.

Department of Surgery, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, Avenue du Champ de Mars, 6, B7000, Mons, Belgium. Jerome.Lechien@umons.ac.be.

Kamal Ragrag

Department of Surgery, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium.

Jason Kasongo

Department of Surgery, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium.

Valentin Favier

Research Committee, Young Otolaryngologists of the International Federation of Otorhinolaryngological Societies, Paris, France.

Department of Otolaryngology-Head and Neck Surgery, CHU de Montpellier, Montpellier, France.

Miguel Mayo-Yanez

Research Committee, Young Otolaryngologists of the International Federation of Otorhinolaryngological Societies, Paris, France.

Otorhinolaryngology-Head and Neck Surgery Department, Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Galicia, Spain.

Carlos M Chiesa-Estomba

Research Committee, Young Otolaryngologists of the International Federation of Otorhinolaryngological Societies, Paris, France.

Department of Otorhinolaryngology-Head & Neck Surgery, Hospital Universitario Donostia, San Sebastian, Spain.

Giannicola Iannella

Research Committee, Young Otolaryngologists of the International Federation of Otorhinolaryngological Societies, Paris, France.

Organi di Senso Department, Sapienza University of Rome, Viale del Policlinico 151, 00161, Rome, Italy.

Giovanni Cammaroto

Research Committee, Young Otolaryngologists of the International Federation of Otorhinolaryngological Societies, Paris, France.

Head-Neck, and Oral Surgery Unit, Department of Head-Neck Surgery, Otolaryngology, Morgagni Pierantoni Hospital, 47121, Forlì, Italy.

Alberto M Saibene

Research Committee, Young Otolaryngologists of the International Federation of Otorhinolaryngological Societies, Paris, France.

Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, 20121, Milan, Italy.

Luigi A Vaira

Research Committee, Young Otolaryngologists of the International Federation of Otorhinolaryngological Societies, Paris, France.

Maxillofacial Surgery Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100, Sassari, Italy.

PhD School of Biomedical Science, Biomedical Sciences Department, University of Sassari, Sassari, Italy.

Florent Carsuzaa

Research Committee, Young Otolaryngologists of the International Federation of Otorhinolaryngological Societies, Paris, France.

Department of Otolaryngology-Head and Neck Surgery, CHU de Poitiers, Poitiers, France.

Kalamkas Sagandykova

Research Committee, Young Otolaryngologists of the International Federation of Otorhinolaryngological Societies, Paris, France.

Department of Otorhinolaryngology, NpJSC “Astana Medical University”, 010000, Astana, Kazakhstan.

Maxime Fieux

Research Committee, Young Otolaryngologists of the International Federation of Otorhinolaryngological Societies, Paris, France.

Hospices Civils de Lyon, Hôpital Lyon Sud, Service d’ORL, d’otoneurochirurgie et de Chirurgie Cervico-Faciale, 69310, Pierre Bénite, France.

Université de Lyon, Université Lyon 1, 69003, Lyon, France.

UMR 5305, Laboratoire de Biologie Tissulaire et d’Ingénierie Thérapeutique, Institut de Biologie et Chimie des Protéines, CNRS/Université Claude Bernard Lyon 1, 7 Passage du Vercors, CEDEX 07, 69003, Lyon, France.

Quentin Lisan

Department of Otolaryngology-Head Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France.

Research Committee, Young Otolaryngologists of the International Federation of Otorhinolaryngological Societies, Paris, France.

Stephane Hans

Department of Otolaryngology-Head Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France.

Research Committee, Young Otolaryngologists of the International Federation of Otorhinolaryngological Societies, Paris, France.

Antonino Maniaci

Research Committee, Young Otolaryngologists of the International Federation of Otorhinolaryngological Societies, Paris, France.

Faculty of Medicine and Surgery, University of Enna Kore, 94100, Enna, Italy.