246 Helicobacter pylori Infection Increases the Risk of Colorectal Polyps: A Large Scale Case-Control Study

Abstract

INTRODUCTION: Persistent Helicobacter pylori (H. pylori) infection begins during childhood and can cause peptic ulcers and gastric cancer. It can also cause extra-gastric organ disease, including idiopathic thrombocytopenic purpura. Although some studies have indicated a correlation between H. pylori infection and the risk of colorectal neoplasms, these findings have not been consistent and are controversial. This case-control study aimed to investigate the association between H. pylori-associated endoscopic gastric mucosal atrophy (GMA) and colorectal polyp occurrence. METHODS: Records of 7394 participants who underwent colonoscopy examinations from August 2008 to July 2018 were reviewed retrospectively. Saved images of endoscopic examinations were used to evaluate the colorectal polyps and GMA. Adjusted odds ratios for predictors of colorectal polyps were computed by using the multiple logistic regression model. RESULTS: A total of 2404 subjects were registered; 1565 (65.1%) were in the GMA-positive group and 1138 (47.3%) had colorectal polyps. The multivariate analysis adjusted by age, sex, smoking habits, alcohol habits, serum lipid levels, hemoglobin A1c (HbA1c), blood pressure, and body mass index indicated that patients in the GMA-positive group more frequently had colorectal polyps compared with patients in the GMA-negative group (odds ratio [OR], 3.27; 95% confidence interval [CI], 2.68–4.01; P < 0.001). An analysis of the association between GMA degree and colorectal polyp status indicated that, compared with mild GMA, severe GMA was associated with a higher risk of proximal colon polyps (OR, 1.47; 95% CI, 1.05–2.07; P = 0.024) and two or more colorectal polyps (OR, 1.80; 95% CI, 1.30–2.49; P < 0.001). CONCLUSION: Colonoscopy examination is useful for discovering colorectal disease, including polyps; however, the examination is more burdensome than esophagogastroduodenoscopy for patients because of the required preparation and invasiveness. This study showed H. pylori-associated GMA found during endoscopy indicated an increased risk for colorectal polyps. Moreover, it also showed severe GMA indicated risks for proximal colon polyps and multiple polyps. These results allow physicians to recommend colonoscopy examinations for specific patients.