Helicobacter pylori positively associated with colorectal cancer and advanced, but not low-risk, adenomas: A retrospective study in China

Abstract

BACKGROUND

In addition to gastric cancer, emerging evidence indicate that individuals treated for Helicobacter pylori (H. pylori) infection experience a significant reduction in both colorectal cancer (CRC) proportion and mortality, suggesting a potential causative role of this infection in CRC. However, in the Chinese population, it remains unclear whether H. pylori infection is involved in the early stages of colorectal carcinogenesis or is associated with the risk of colorectal polyps (CPs). Therefore, we conducted a retrospective study based on 5986 gastroscopy and colonoscopy patients without a treatment history of H. pylori in Zhejiang Province (China).

AIM

To investigate H. pylori’s association with CRC and the different types of CPs, and its potential to alter their risks.

METHODS

A retrospective cross-sectional study was performed with 5986 patients who had undergone gastroscopy and colonoscopy. Pearson χ² test was used for analyzing how H. pylori are correlated to various CPs and CRC. H. pylori as a risk factor for various CPs and CRC was determined by multivariable logistic regression.

RESULTS

H. pylori-positive patients demonstrated a significantly higher proportion of advanced adenomas (AAs) than negative patients (7.51% vs 5.61%; P = 0.006), with a non-significant increase in CRC proportion (1.45% vs 1.15%). No significant differences were observed for non-adenomatous polyps or low-risk adenomas, and infection levels showed no association with CRC or CPs proportion. H. pylori infection was linked to a more distal CRC location (P < 0.05) but not to AAs characteristics. Furthermore, the analysis showed an association between H. pylori infection and increased odds of AAs (odds ratio = 1.53, 95% confidence interval: 1.20-1.93) and RC (odds ratio = 1.70, 95% confidence interval: 1.01-2.80).

CONCLUSION

In a similar clinical population of Chinese, H. pylori infection may be a risk factor for both AAs and CRC but not non-adenomatous polyps or low-risk adenomas. This suggests that H. pylori-positive patients should prioritize colonoscopy.

Keywords: Helicobacter pylori; Colorectal advanced adenomas; Colorectal cancer; Retrospective cross-sectional study; Multivariable logistic regression analysis

Core Tip: In the Chinese population, it remains unclear whether Helicobacter pylori (H. pylori) infection is involved in the early stages of colorectal carcinogenesis or is associated with the risk of colorectal polyps. We conducted a retrospective study based on 5986 gastroscopy and colonoscopy patients without a treatment history of H. pylori in Zhejiang Province (China). We found that H. pylori infection was a risk factor for both advanced adenomas and colorectal cancer in a similar clinical population of Chinese, but not non-adenomatous polyps or low-risk adenomas. Therefore, H. pylori-positive patients should undergo colonoscopy.