Shan N, Hou JJ, Jin CQ, Jin Q, Qin YH, Li WW. Helicobacter pylori positively associated with colorectal cancer and advanced, but not low-risk, adenomas: A retrospective study in China. World J Gastrointest Surg 2026; 18(4): 117397 [DOI: 10.4240/wjgs.v18.i4.117397]
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05755618
Submitted on:
April 27, 2026, 02:35
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Reader Comments:
This retrospective study analyzed data from 5,986 patients in Zhejiang Province, China, to investigate the association between Helicobacter pylori (H. pylori) infection and colorectal cancer (CRC) and colorectal adenomas, particularly advanced adenomas (AAs). The prevalence of advanced adenomas was significantly higher in H. pylori–positive patients compared to uninfected individuals. Although the prevalence of CRC was also slightly higher in the infected group, the difference did not reach statistical significance. H. pylori infection was not associated with non-adenomatous polyps (NAPs) or low-risk adenomas (LRAs).
Multivariate logistic regression analysis identified H. pylori infection as a risk factor for both advanced adenomas and CRC. No significant differences were observed in the prevalence of adenomas or CRC across degrees of H. pylori infection. In H. pylori–positive patients, CRC lesions were more frequently located in the distal colon (left colon and rectum). Male sex and older age were also identified as risk factors for advanced adenomas and CRC.
This study suggests that H. pylori infection may contribute to the development of advanced adenomas and CRC and recommends prioritizing colonoscopic evaluation in H. pylori–positive patients. In particular, patients at high risk of advanced adenomas (H. pylori–positive, male, and elderly) may benefit from regular colonoscopic surveillance for early detection and treatment. It is a fascinating study.
However, in my opinion, several concerns have been raised. In this study, H. pylori infection status and infection level were evaluated using gastric mucosal biopsy specimens, but the specific biopsy sites (e.g., antrum or corpus) were not described in detail. Generally, biopsy from the antrum and/or corpus is recommended for accurate detection of H. pylori, whereas this study refers only to “gastric mucosal specimens.”
Furthermore, the manuscript does not address the distinction between viable and non-viable H. pylori, nor the clinical significance of non-viable bacteria. The assessment of H. pylori infection in this study appears to be based on the presence of organisms observed in histological specimens, which typically reflects viable bacteria associated with infection and disease risk. In contrast, non-viable bacteria do not confer infectivity but may still contribute to immune responses. In clinical practice, accurate diagnosis of H. pylori infection can be challenging, and this issue warrants further discussion.