目前存在着关于幽门螺杆菌（Hp）根除是否能够逆转包括肠化生在内的胃癌前病变的疑问，这一问题仍然不确定，引发了持续的争论。因此，进行了一项Meta分析，以评估Hp根除对胃癌前病变的影响。从PubMed、Embase、Cochrane图书馆、科学引文索引数据库、Scopus数据库和ClinicalTrials.gov从创建至2023年4月进行系统检索，以寻找探索Hp根除对胃癌前病变影响的研究。选择风险比（RRs）及其95%的置信区间（95% CIs）作为效果大小。我们使用随机效应模型评估汇总数据。我们还进行了质量评估、亚组分析和敏感性分析。共纳入了15项研究。与安慰剂相比，Hp根除可以显著预防胃癌前病变的进展（RR = 0.87，95% CI：0.81-0.94，p < 0.01）并逆转它们（RR = 1.32，95% CI：1.17-1.50，p < 0.01）。然后，进一步探讨了具体的癌前病变。与安慰剂或无治疗相比，Hp根除可以显著预防肠化生的进展（RR = 0.80，95% CI：0.69-0.94，p < 0.01）。此外，与安慰剂或无治疗相比，Hp根除也改善了慢性萎缩性胃炎（RR = 1.84，95% CI：1.30-2.61，p < 0.01）和肠化生（RR = 1.41，95% CI：1.15-1.73，p < 0.01）。然而，在预防畸形进展（RR = 0.86，95% CI：0.37-2.00）和改善畸形（RR = 0.89，95% CI：0.47-1.70）方面，Hp根除与安慰剂或无治疗相比没有优势。Hp根除治疗可以预防胃癌前病变的进展并逆转它们。值得注意的是，肠化生可以逆转，但这可能只适用于具有表观遗传改变和较轻病变的患者。© 2023 The Authors. Helicobacter published by John Wiley & Sons Ltd.

The question of whether eradication of Helicobacter pylori (Hp) can reverse gastric precancerous lesions, including intestinal metaplasia, remains uncertain, leading to ongoing debate. Therefore, a meta-analysis was performed to evaluate the effect of Hp eradication on gastric precancerous lesions.PubMed, Embase, Cochrane Library, Web of Science, Scopus database, and ClinicalTrials.gov were systematically searched from inception to April 2023 for studies that explored the impact of Hp eradication on gastric precancerous lesions. Risk ratios (RRs) and their 95% confidence intervals (95% CIs) were selected as the effect size. We used the random-effects model to assess pooled data. We also performed quality assessments, subgroup analyses, and sensitivity analyses.Fifteen studies were included. Compared with placebo, Hp eradication could significantly prevent the progression of gastric precancerous lesions (RR = 0.87, 95% CI: 0.81-0.94, p < 0.01) and reverse them (RR = 1.32, 95% CI: 1.17-1.50, p < 0.01). Then, specific precancerous lesions were further explored. The progression of intestinal metaplasia was significantly prevented by Hp eradication compared to placebo or no treatment (RR = 0.80, 95% CI: 0.69-0.94, p < 0.01). Moreover, compared with placebo or no treatment, Hp eradication also improved chronic atrophic gastritis (RR = 1.84, 95% CI: 1.30-2.61, p < 0.01) and intestinal metaplasia (RR = 1.41, 95% CI: 1.15-1.73, p < 0.01). However, in terms of preventing dysplasia progression (RR = 0.86, 95% CI: 0.37-2.00) and improving dysplasia (RR = 0.89, 95% CI: 0.47-1.70), Hp eradication had no advantage compared to placebo or no treatment.Hp eradication therapy could prevent the progression of gastric precancerous lesions and reverse them. Notably, intestinal metaplasia can be reversed, but this may only be appropriate for patients with epigenetic alterations and milder lesions.© 2023 The Authors. Helicobacter published by John Wiley & Sons Ltd.