S2121 Impact of Helicobacter pylori Eradication on Ghrelin Levels and BMI: Single-Arm Meta-Analysis With Leave-One-Out Sensitivity Analysis
Bibliographic record
Abstract
Introduction: A persistent Helicobacter pylori infection suppresses the production of gastric ghrelin, which may restrict appetite and growth. Although eradication therapy may increase endocrine production, its effect on body weight is still up for debate, which feeds worries about obesity and hopes for better nutrition. We combined longitudinal studies that assessed body-mass index (BMI) and circulating ghrelin levels before and after confirmed eradication to provide clarity. Methods: A systematic search of MEDLINE, Embase, Scopus and CENTRAL were searched for trials or cohorts reporting paired pre/post ghrelin or BMI ≥4 weeks after confirmed eradication through May 2025. Two reviewers screened, extracted means ±SD and judged bias with RoB 2 or Newcastle-Ottawa. Pooled mean differences were generated with DL random effects model; heterogeneity was summarized by τ² and I². Forest plots displayed effect sizes, while leave-one-out plots located influential studies. Data analysis was done using R (v4.4.3) with 'meta' package. Results: Six studies, comprising 1,002 participants, assessed changes in ghrelin levels and BMI following H. pylori eradication. For BMI change, the random-effects model showed a non-significant mean difference (MD) of 0.79 (95% confidence interval [CI]: -0.52 to 2.10) with high heterogeneity (I² = 84.4%, τ² = 1.66). Leave-one-out analysis revealed that excluding Choe et al. (2007) reduced heterogeneity to 0% and yielded an MD of 0.28 (95% CI: -0.04 to 0.61). For ghrelin levels, eradication significantly increased levels with an MD of 163.60 (95% CI: 111.19 to 216.01) but showed extreme heterogeneity (I² = 99.9%, τ² = 4191.47). Sensitivity analysis found all studies contributed to high heterogeneity except Lane et al (2011) whose exclusion lowered I² to 83.9% and resulted in an MD of 3.42 (95% CI: -2.80 to 9.64). Conclusion: These results suggest H. pylori eradication raises ghrelin and may modestly raise BMI, but heterogeneity limits firm conclusions. The rebound confirms infection suppression yet seldom yields clinically relevant weight gain. Pediatric studies showed small increases, whereas adult community trials and dialysis cohorts were weight-neutral, explaining most dispersion. Leave-one-out influence plots demonstrated that removing such context-specific outliers normalized heterogeneity and centered BMI effects on null. Clinically, eradication seems to restore endocrine balance without promoting obesity, though longer, better-powered trials across diverse metabolic profiles are needed.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.070 | 0.119 |
| Meta-epidemiology (narrow) | 0.005 | 0.002 |
| Meta-epidemiology (broad) | 0.022 | 0.101 |
| Bibliometrics | 0.005 | 0.004 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.003 |
| Open science | 0.004 | 0.002 |
| Research integrity | 0.005 | 0.004 |
| Insufficient payload (model declined to judge) | 0.017 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".