Published online Oct 7, 2020. doi: 10.3748/wjg.v26.i37.5682
Peer-review started: April 21, 2020
First decision: May 1, 2020
Revised: May 29, 2020
Accepted: September 9, 2020
Article in press: September 9, 2020
Published online: October 7, 2020
The significance of Helicobacter pylori (H. pylori) infection and atrophic gastritis (AG) in the prevalence of colorectal adenomas has been examined in a limited number of studies. However, these studies reported disputed conclusions.
To investigate whether H. pylori infection, AG, and H. pylori-related AG increase the risk of colorectal adenomas.
This retrospective cross-sectional study included 6018 health-check individuals. The relevant data for physical examination, laboratory testing, 13C-urea breath testing, gastroscopy, colonoscopy and histopathological examination of gastric and colorectal biopsies were recorded. Univariate and multivariate logistic regression analyses were performed to determine the association between H. pylori-related AG and colorectal adenomas.
Overall, 1012 subjects (16.8%) were diagnosed with colorectal adenomas, of whom 143 (2.4%) had advanced adenomas. Among the enrolled patients, the prevalence of H. pylori infection and AG was observed as 49.5% (2981/6018) and 10.0% (602/6018), respectively. Subjects with H. pylori infection had an elevated risk of colorectal adenomas (adjusted odds ratio [OR] of 1.220, 95% confidence interval (CI): 1.053-1.413, P = 0.008) but no increased risk of advance adenomas (adjusted OR = 1.303, 95%CI: 0.922-1.842, P = 0.134). AG was significantly correlated to an increased risk of colorectal adenomas (unadjusted OR = 1.668, 95%CI: 1.352-2.059, P < 0.001; adjusted OR = 1.237, 95%CI: 0.988-1.549, P = 0.064). H. pylori infection accompanied by AG was significantly associated with an increased risk of adenomas (adjusted OR = 1.491, 95%CI: 1.103-2.015, P = 0.009) and advanced adenomas (adjusted OR = 1.910, 95%CI: 1.022-3.572, P = 0.043).
H. pylori-related AG was associated with a high risk of colorectal adenomas and advanced adenomas in Chinese individuals.
Core Tip: The relationship among Helicobacter pylori (H. pylori), atrophic gastritis (AG), and colorectal adenomas has been inconclusive. We conducted this retrospective study on 6018 health-check individuals and observed that H. pylori-related AG is an independent risk factor for colorectal adenomas in Chinese individuals. Clinically, rigorous colonoscopy screening and monitoring may be necessary for individuals with H. pylori-positive AG.