The Association between Helicobacter pylori and Colorectal Neoplasia

• Published in: Medical principles and practice Vol. 32; no. 1; pp. 77 - 85
• Main Authors: Wernly, Sarah, Semmler, Georg, Flamm, Maria, Rezar, Richard, Aigner, Elmar, Datz, Christian, Wernly, Bernhard
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland S. Karger AG 01.06.2023
• Subjects: Body mass index; Chemotherapy; Colonoscopy; Colorectal cancer; Colorectal Neoplasms - diagnosis; Colorectal Neoplasms - epidemiology; Cross-Sectional Studies; Dependent variables; Family medical history; Helicobacter Infections - complications; Helicobacter Infections - epidemiology; Helicobacter pylori; Humans; Metabolic syndrome; Original Paper; Patients; Regression analysis; Risk Factors; Smoking; Colorectal neoplasms; Helicobacter pylori; Metabolic syndrome; Cancer screening
• ISSN: 1011-7571; 1423-0151; 1423-0151
• DOI: 10.1159/000528794

Objectives: Helicobacter pylori (H. pylori) and colorectal neoplasia (CRN) are frequent entities. Epidemiological data suggest an association between H. pylori positivity (H. pylori +) and CRN, whereas pathophysiologic considerations substantiate a possible causal relationship. However, the relationship between CRN and H. pylori + may also be mediated by shared risk factors. Therefore, the aim of this cross-sectional study was to evaluate a possible independent relationship between H. pylori and CRN in a Central European cohort. Methods: We included 5,707 asymptomatic patients. All patients underwent screening colonoscopy and upper gastrointestinal endoscopy. We assessed the association between any CRN and advanced CRN with H. pylori + using multilevel logistic regression. We adjusted for age, sex, a positive family history of colorectal cancer, and cardiovascular risk. Results: 1,082 patients (19%) were H. pylori + and 4,625 (81%) H. pylori −. Patients with both CRN and H. pylori had more cardiometabolic risk factors. In univariate (aOR 1.20; 1.10–1.31) and multivariable analysis (aOR 1.20; 1.08–1.32), H. pylori + was associated with the diagnosis of any CRN. However, H. pylori + was associated with the presence of advanced CRN (aOR 1.26; 0.96–1.64) only in trend. Conclusions: We found a clustered co-occurrence of CRN and H. pylori. This association persisted after correction for shared cardiometabolic risk factors. We suggest that our analysis emphasizes the clinical value of H. pylori eradication. Whether “test and treat” H. pylori is warranted to prevent CRN remains unclear but is at least a possibility given the simplicity of “test and treat.”