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H. pylori infection increased risk for colonic neoplasms
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Gastritis related to Helicobacter pylori infection was associated with an elevated risk for colonic neoplasms in a recent study.
Researchers evaluated biopsy results from 156,269 patients (59% women) who received colonoscopy and esophago-gastro-duodenoscopy from January 2008 through December 2011. Biopsy data were available from multiple sites in 53% of cases, from the antrum in 85%, the corpus in 60% and the cardia in 10%.
Hyperplastic (OR=1.24, 1.18-1.30 compared with normal gastric mucosa) and adenomatous polyps (OR=1.52, 1.46-1.57), advanced adenomas (OR=1.80, 1.69-1.92), villous adenomas or those with high-grade dysplasia (OR=1.97, 1.82-2.14) and adenocarcinomas (OR=2.35, 1.98-2.80) were more common among patients with H. pylori-positive gastritis. The association between colonic neoplasms and H. pylori gastritis was observed throughout specific locations in the large bowel. ORs ranged from 1.23 (1.19-1.27) in the transverse colon to 1.52 (1.43-1.61) in the descending colon, and strengthened based on adenoma presence (OR=1.50, 1.44-1.56 for one to two adenomas vs. OR=3.40, 1.05-11.05 for 10 or more) (95% CI for all).
Investigators also observed associations between intestinal metaplasia and hyperplastic polyps (OR=1.42, 1.31-1.54), adenomas (OR=1.82, 1.71-1.94), advanced adenomas (OR=2.02, 1.82-2.24) and colon cancer (OR=2.55, 1.93-3.37) (95% CI for all). These associations persisted throughout the large bowel and were impacted by adenoma quantity.
Multivariate analysis indicated that hyperplastic (OR=1.06, 1.02-1.10) and adenomatous polyps (OR=1.29, 1.24-3.33), adenocarcinoma (OR=1.93, 1.62-2.30) and villous adenomas or those with high-grade dysplasia (OR=1.31, 1.21-1.42) were all independent contributors to the association between H. pylori gastritis and colonic neoplasms. Similar associations were observed for the association between neoplasms and intestinal metaplasia (95% CI for all).
“The data from a large national database of patients who underwent both upper and lower gastrointestinal endoscopy reveal that H. pylori gastritis confers an increased risk for colonic neoplasm,” the researchers concluded. “Such risk is not limited to H. pylori gastritis, but is found similarly in other types of gastric histopathology, such as gastric intestinal metaplasia. The mechanism underlying this risk association is presently not fully understood.”
Disclosure: Researcher Amnon Sonnenberg is supported by a grant from Takeda Pharmaceuticals. Researcher Robert M. Genta is an employee of Miraca Life Sciences.
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