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
ARTICLE HIGHLIGHTS
Research background

Gastric Helicobacter pylori (H. pylori) infection is a global public health problem. It is associated with chronic gastritis, gastroduodenal ulcer and gastric malignancies. The relationship between H. pylori infection and the risk of colorectal polyps and colorectal cancer (CRC) has also received extensive attention in recent years.

Research motivation

There is still no clear conclusion regarding the relationship between gastric H. pylori infection and the risk of colorectal polyps and CRC.

Research objectives

Our main purpose was to investigate the correlation between gastric H. pylori infection and the risk of colorectal polyps and CRC, which is essential for the early screening and detection of colorectal precancerous lesions.

Research methods

A retrospective analysis of 6538 patients who underwent colonoscopy was conducted. The patients were divided into three groups: The CRC group, colorectal polyps group, and the control group. All subjects completed a 14C-urea breath test, bidirectional gastrointestinal endoscopy, and a biopsy on the same day. The characteristics of gastrointestinal endoscopy, pathology of gastritis, polyps and CRC, and the detection of H. pylori in the three groups were analyzed.

Research results

Patients with H. pylori infection were 2.19 times more likely to develop colorectal polyps and 3.05 times more likely to develop CRC than those who did not have H. pylori infection. The prevalence of H. pylori infection was higher in the multiple polyps group than in the solitary polyp group, and was also higher in the adenomatous polyps group than in the non-adenomatous polyps group. Additionally, we found that the incidence of H. pylori infection coexisting with atrophic gastritis or intestinal metaplasia was higher in patients with colorectal polyps and CRC than in the control group. The size and location of polyps, the histopathological characteristics and the location of CRC were not related to H. pylori infection.

Research conclusions

The incidence of colonic polyps and CRC in patients with gastric H. pylori infection and H. pylori-associated atrophic gastritis or intestinal metaplasia was significantly higher than that in the normal population. Early and frequent colonoscopy is necessary to reduce the risk of colonic polyps and CRC in patients with H. pylori infection. The mechanism by which gastric H. pylori infection increases the incidence of colorectal polyps and CRC should be further studied.

Research perspectives

This study demonstrates that early colonoscopy screening and surveillance are necessary to reduce the risk of colonic polyps and CRC in patients with H. pylori infection. The future direction of research is to evaluate whether the eradication of gastric H. pylori can reduce the occurrence of colorectal polyps and CRC. Large-scale and long-term follow-up investigations are needed.