The Association between Helicobacter pylori and Colorectal Neoplasia

Objectives: Both Helicobacter pylori (H. pylori) and colorectal neoplasia (CRN) are frequent entities in gastroenterology. Epidemiological data suggest an association between H. pylori positivity (H. pylori +) and CRN, whereas pathophysiologic considerations substantiate a possible causal relationship. However, the relationship between CRN and H. pylori+ may also be mediated by shared risk factors. Therefore, the aim of this cross-sectional study was to evaluate a possible independent relationship between H.pylori and CRN in a Central European cohort.Methods: We included 5,707 asymptomatic patients in this study. All patients underwent screening colonoscopy and upper gastrointestinal endoscopy. We assessed the association between any and advanced CRN and H. pylori + using multilevel logistic regression. We adjusted for age, sex, a positive family history of colorectal cancer and cardiovascular risk.Results: 1,082 patients (19%) were H. pylori + and 4,625 (81%) H. pylori -. Both patients with CRN and H. pylori had more cardiometabolic risk factors. In both univariate (aOR 1.20 1.10-1.31; p<0.001) and multivariable analysis (aOR 1.20 1.08-1.32; p<0.001), H. pylori + was associated with the diagnosis of any CRN. However, we found that H. pylori + was associated with the presence of advanced CRN (aOR 1.26; 0.96-1.64; p=0.10) only in trend.Conclusions: We found a clustered co-occurrence of CRN and H. pylori. This association persisted after correction for shared cardiometabolic risk factors. We think that our analysis emphasizes the clinical value of H. pylori eradication. Whether "test and treat" H. pylori is warranted to prevent CRN remains unclear but is at least a possibility given the simplicity of "test and treat".