Published online May 15, 2020. doi: 10.4251/wjgo.v12.i5.582
Peer-review started: December 29, 2019
First decision: January 19, 2020
Revised: March 13, 2020
Accepted: March 24, 2020
Article in press: March 24, 2020
Published online: May 15, 2020
Processing time: 136 Days and 19.3 Hours
Gastric Helicobacter pylori (H. pylori) infection is a global public health problem. It is associated with chronic gastritis, gastroduodenal ulcer and gastric malignancies. The relationship between H. pylori infection and the risk of colorectal polyps and colorectal cancer (CRC) has also received extensive attention in recent years.
There is still no clear conclusion regarding the relationship between gastric H. pylori infection and the risk of colorectal polyps and CRC.
Our main purpose was to investigate the correlation between gastric H. pylori infection and the risk of colorectal polyps and CRC, which is essential for the early screening and detection of colorectal precancerous lesions.
A retrospective analysis of 6538 patients who underwent colonoscopy was conducted. The patients were divided into three groups: The CRC group, colorectal polyps group, and the control group. All subjects completed a 14C-urea breath test, bidirectional gastrointestinal endoscopy, and a biopsy on the same day. The characteristics of gastrointestinal endoscopy, pathology of gastritis, polyps and CRC, and the detection of H. pylori in the three groups were analyzed.
Patients with H. pylori infection were 2.19 times more likely to develop colorectal polyps and 3.05 times more likely to develop CRC than those who did not have H. pylori infection. The prevalence of H. pylori infection was higher in the multiple polyps group than in the solitary polyp group, and was also higher in the adenomatous polyps group than in the non-adenomatous polyps group. Additionally, we found that the incidence of H. pylori infection coexisting with atrophic gastritis or intestinal metaplasia was higher in patients with colorectal polyps and CRC than in the control group. The size and location of polyps, the histopathological characteristics and the location of CRC were not related to H. pylori infection.
The incidence of colonic polyps and CRC in patients with gastric H. pylori infection and H. pylori-associated atrophic gastritis or intestinal metaplasia was significantly higher than that in the normal population. Early and frequent colonoscopy is necessary to reduce the risk of colonic polyps and CRC in patients with H. pylori infection. The mechanism by which gastric H. pylori infection increases the incidence of colorectal polyps and CRC should be further studied.
This study demonstrates that early colonoscopy screening and surveillance are necessary to reduce the risk of colonic polyps and CRC in patients with H. pylori infection. The future direction of research is to evaluate whether the eradication of gastric H. pylori can reduce the occurrence of colorectal polyps and CRC. Large-scale and long-term follow-up investigations are needed.