Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. May 15, 2020; 12(5): 582-591
Published online May 15, 2020. doi: 10.4251/wjgo.v12.i5.582
Association of Helicobacter pylori infection with colorectal polyps and malignancy in China
Man Wang, Wen-Jie Kong, Jing-Zhan Zhang, Jia-Jie Lu, Wen-Jia Hui, Wei-Dong Liu, Xiao-Jing Kang, Feng Gao
Man Wang, Wen-Jie Kong, Jia-Jie Lu, Wen-Jia Hui, Wei-Dong Liu, Feng Gao, Department of Gastroenterology, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830001, Xinjiang Uygur Autonomous Region, China
Jing-Zhan Zhang, Xiao-Jing Kang, Department of Dermatology, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830001, Xinjiang Uygur Autonomous Region, China
Author contributions: Wang M and Gao F designed the study; Wang M, Kong WJ and Lu JJ acquired the data and drafted the article; Hui WJ and Liu WD analyzed and interpreted the data; Zhang JZ and Kang XJ revised the article critically for important intellectual content; all the authors approved the version to be published.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the People’s Hospital of Xinjiang Uygur Autonomous Region.
Informed consent statement: No consent was required as this was a retrospective study.
Conflict-of-interest statement: All authors declare no conflicts-of-interest related to this article.
Data sharing statement: The datasets collected and/or analyzed during the current study are available from the corresponding author upon reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Feng Gao, MD, PhD, Chairman, Professor, Department of Gastroenterology, People’s Hospital of Xinjiang Uygur Autonomous Region, No. 91, Tianchi Road, Tianshan District, Urumqi 830001, Xinjiang Uygur Autonomous Region, China. drxjgf@sina.com
Received: December 29, 2019
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
Abstract
BACKGROUND

Gastric Helicobacter pylori (H. pylori) infection is related to chronic gastritis, gastroduodenal ulcer, and gastric malignancies; whether this infection is related to colorectal polyps and colorectal cancer (CRC), remains debatable.

AIM

To investigate the relationship between gastric H. pylori infection and the risk of colorectal polyps and CRC.

METHODS

We retrospectively analyzed 3872 patients with colorectal polyps who underwent colonoscopy and pathological diagnosis. We also analyzed 304 patients with primary CRC. The characteristics of these patients were compared with those of the control group, which included 2362 patients with the normal intestinal mucosa. All subjects completed a 14C-urea breath test, bidirectional gastrointestinal endoscopy, and a biopsy on the same day. Data on the number, size, location, and pathology of the polyps, the location, and pathology of the CRC, the detection of H. pylori, and the incidence of H. pylori-associated atrophic gastritis or intestinal metaplasia were obtained. A logistic regression model was used to analyze the relationship between gastric infection due to H. pylori, and the incidence of colorectal polyps and CRC.

RESULTS

The prevalence of H. pylori infection was higher in the multiple polyps group than in the solitary polyp group and the control group [95% confidence interval (CI) = 1.02-1.31, P = 0.03; 95%CI: 2.12-2.74, P < 0.001]. The patients with adenomatous polyps had a higher incidence of H. pylori infection than patients with non-adenomatous polyps [59.95% vs 51.75%, adjusted odds ratio (OR) = 1.41, 95%CI: 1.24-1.60, P < 0.01]. Patients with H. pylori-associated atrophic gastritis or intestinal metaplasia were at high risk of CRC (adjusted OR = 3.46, 95%CI: 2.63-4.55, P < 0.01; adjusted OR = 4.86, 95%CI: 3.22-7.34, P < 0.01, respectively). The size and location of the polyps, the histopathological characteristics and the location of CRC were not related to H. pylori infection.

CONCLUSION

Our study demonstrates that the incidence of gastric H. pylori infection and H. pylori-associated atrophic gastritis or intestinal metaplasia elevates the risk of colorectal polyps and CRC.

Keywords: Helicobacter pylori, Atrophic gastritis, Intestinal metaplasia, Polyps, Colorectal cancer, Gastrointestinal neoplasms

Core tip: This study investigated the association of gastric Helicobacter pylori (H. pylori) infection with the risk of colorectal polyps and colorectal cancer (CRC). The results indicated that patients with H. pylori infection were 2.19 and 3.05 times more likely to develop colorectal polyps and CRC, respectively, than those without H. pylori infection. The prevalence of H. pylori infection was higher in the patient group with multiple polyps and colorectal adenomas than in those with a solitary polyp and non-adenomatous polyps, respectively. Gastric H. pylori infection and H. pylori-associated atrophic gastritis or intestinal metaplasia elevated the risk of colorectal polyps and CRC. Therefore, earlier and frequent colonoscopy is necessary.