Published online May 14, 2016. doi: 10.3748/wjg.v22.i18.4576
Peer-review started: December 25, 2015
First decision: January 28, 2016
Revised: February 11, 2016
Accepted: March 1, 2016
Article in press: March 2, 2016
Published online: May 14, 2016
Processing time: 131 Days and 8.8 Hours
AIM: To explore the correlation between Helicobacter pylori (H. pylori)-associated gastric diseases and colorectal neoplasia.
METHODS: Patients included in this study underwent a colonoscopy and esophago-gastro-duodenoscopy (EGD) along with histopathological measurement between March 2012 and March 2015 at Qi-Lu Hospital of Shandong University, who also had results of H. pylori detection. A total of 233 cases were selected. Demographic data, H. pylori infection status (including results of rapid urease tests and gastric mucosa pathological examinations) and histopathological examination results of gastric and colorectal mucosa were gathered and analyzed. The statistical analysis focused on the prevalence of colorectal neoplasms among patients with various histopathological categories of the stomach. ORs and their 95%CI were calculated to describe the strengths of the associations.
RESULTS: The incidence rates of colorectal adenoma without high-grade intraepithelial neoplasia (HGIEN) (OR = 2.400, 95%CI: 0.969-5.941), adenoma with HGIEN (5.333, 1.025-27.758) and adenocarcinoma (1.455, 0.382-5.543) were all higher for patients with H. pylori-associated gastritis than for those in the control group. The incidence rate of colorectal adenoma with HGIEN (3.218, 0.767-13.509) was higher in patients with intestinal metaplasia than in the control group, while the incidence rates of adenoma without HGIEN (0.874, 0.414-1.845) and adenocarcinoma (0.376, 0.096-1.470) were lower in the intestinal metaplasia group than in the control group. The incidence rate of colorectal adenoma without HGIEN (3.111, 1.248-7.753) was significantly higher in the gastric intraepithelial neoplasia group than in the control group, while the rates of adenoma with HGIEN (1.481, 0.138-15.941) and adenocarcinoma (2.020, 0.561-7.272) were higher in the gastric intraepithelial neoplasia group. Incidence rates of colorectal adenoma without HGIEN (1.067, 0.264-4.314), adenoma with HGIEN (2.667, 0.231-30.800) and adenocarcinoma (2.182, 0.450-10.585) were all higher in the gastric adenocarcinoma group than in the control group.
CONCLUSION: H. pylori infection as well as H. pylori-associated gastric diseases are risk factors for colorectal neoplasia.
Core tip: Few studies have investigated the relationship between Helicobacter pylori (H. pylori)-associated gastric diseases and colorectal neoplasia. In particular, no such research on the Chinese population has been reported so far. To explore this correlation in the Chinese population, demographic data, H. pylori infection status and histopathological data of gastric and colorectal mucosa of 233 Chinese patients were gathered and analyzed. The results demonstrated that H. pylori-associated gastric diseases might increase the risk of colorectal neoplasia regardless of the number, size and location of the neoplasm. Therefore, we can assume that H. pylori-associated gastric diseases are potential risk factors for colorectal neoplasia in the Chinese population.