Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 7, 2020; 26(37): 5682-5692
Published online Oct 7, 2020. doi: 10.3748/wjg.v26.i37.5682
Helicobacter pylori infection with atrophic gastritis: An independent risk factor for colorectal adenomas
Qin-Fen Chen, Xiao-Dong Zhou, Dan-Hong Fang, En-Guang Zhang, Chun-Jing Lin, Xiao-Zhen Feng, Na Wang, Jian-Sheng Wu, Dan Wang, Wei-Hong Lin
Qin-Fen Chen, Dan-Hong Fang, En-Guang Zhang, Chun-Jing Lin, Xiao-Zhen Feng, Na Wang, Jian-Sheng Wu, Dan Wang, Wei-Hong Lin, Department of Physical Examination Medical Care Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
Xiao-Dong Zhou, Department of Cardiovascular Medicine, The Key Laboratory of Cardiovascular Diseases of Wenzhou, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
Author contributions: Chen QF and Zhou XD contributed equally to this work; Chen QF, Zhou XD, Lin WH, Wang D and Wu JS designed the study; Chen QF, Zhou XD, Feng XZ and Wang N collected data; Chen QF, Zhou XD and Fang DH did the statistical analyses; Chen QF, Zhou XD, Zhang EG and Lin CJ reviewed the results, interpreted data and wrote the manuscript; Lin WH and Wang D are both corresponding authors; All authors have made an intellectual contribution to the manuscript and approved the submission.
Institutional review board statement: The investigation conforms to the principles outlined in the Declaration of Helsinki. The study was approved by the ethical committee of The First Affiliated Hospital of Wenzhou Medical University Ethical Committee.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to examination by verbal consent. Individuals can’t be identified according to the data presented.
Conflict-of-interest statement: All authors declare that they have no conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Wei-Hong Lin, MD, Nurse, Department of Physical Examination Medical Care Center, The First Affiliated Hospital of Wenzhou Medical University, No. 2 Fuxue Lane, Wenzhou 325000, Zhejiang Province, China. linweihong@wmu.edu.cn
Received: April 21, 2020
Peer-review started: April 21, 2020
First decision: May 1, 2020
Revised: May 29, 2020
Accepted: September 9, 2020
Article in press: September 9, 2020
Published online: October 7, 2020
Processing time: 159 Days and 18.7 Hours
Abstract
BACKGROUND

The significance of Helicobacter pylori (H. pylori) infection and atrophic gastritis (AG) in the prevalence of colorectal adenomas has been examined in a limited number of studies. However, these studies reported disputed conclusions.

AIM

To investigate whether H. pylori infection, AG, and H. pylori-related AG increase the risk of colorectal adenomas.

METHODS

This retrospective cross-sectional study included 6018 health-check individuals. The relevant data for physical examination, laboratory testing, 13C-urea breath testing, gastroscopy, colonoscopy and histopathological examination of gastric and colorectal biopsies were recorded. Univariate and multivariate logistic regression analyses were performed to determine the association between H. pylori-related AG and colorectal adenomas.

RESULTS

Overall, 1012 subjects (16.8%) were diagnosed with colorectal adenomas, of whom 143 (2.4%) had advanced adenomas. Among the enrolled patients, the prevalence of H. pylori infection and AG was observed as 49.5% (2981/6018) and 10.0% (602/6018), respectively. Subjects with H. pylori infection had an elevated risk of colorectal adenomas (adjusted odds ratio [OR] of 1.220, 95% confidence interval (CI): 1.053-1.413, P = 0.008) but no increased risk of advance adenomas (adjusted OR = 1.303, 95%CI: 0.922-1.842, P = 0.134). AG was significantly correlated to an increased risk of colorectal adenomas (unadjusted OR = 1.668, 95%CI: 1.352-2.059, P < 0.001; adjusted OR = 1.237, 95%CI: 0.988-1.549, P = 0.064). H. pylori infection accompanied by AG was significantly associated with an increased risk of adenomas (adjusted OR = 1.491, 95%CI: 1.103-2.015, P = 0.009) and advanced adenomas (adjusted OR = 1.910, 95%CI: 1.022-3.572, P = 0.043).

CONCLUSION

H. pylori-related AG was associated with a high risk of colorectal adenomas and advanced adenomas in Chinese individuals.

Keywords: Helicobacter pylori; Gastritis; Atrophy; Adenomas; Colorectal; Health-check

Core Tip: The relationship among Helicobacter pylori (H. pylori), atrophic gastritis (AG), and colorectal adenomas has been inconclusive. We conducted this retrospective study on 6018 health-check individuals and observed that H. pylori-related AG is an independent risk factor for colorectal adenomas in Chinese individuals. Clinically, rigorous colonoscopy screening and monitoring may be necessary for individuals with H. pylori-positive AG.