H. pylori is Implicated in Colorectal Adenomas

High prevalence of Helicobacter pylori infection in patients with colonic adenomas and carcinomas. G Meucci, M Tatarella, M Vecchi, ML Ranzi, E Biguzzi, G Beccari, E Clerici, R de Franchis. J Clin Gastroenterol 1997 Dec;25(4):605-607. 50 study patients and 100 controls, plus 44 additional consecutive patients. "The prevalence of H. pylori antibodies was 49 (49%) of 100 in control subjects, 40 (71.4%) of 56 in patients with polyps (p < 0.006 vs. control subjects), and 21 (55%) of 38 in patients with cancer (not significant). Among patients with colorectal cancer, H. pylori prevalence was 9 (69.2%) of 13 for patients evaluated at the time of diagnosis and 12 (48%) of 25 for patients evaluated 1 to 9 years after surgery."

Meucci - J Clin Gastroenterol 1997 abstract / PubMed

Helicobacter pylori and the risk of colonic adenomas. Colorectal Adenoma Study Group. B Breuer-Katschinski, K Nemes, A Marr, B Rump, B Leiendecker, N Breuer, H Goebell. Digestion 1999;60(3):210-215. 98 patients with colorectal adenomas, versus hospital controls and population controls. "H. pylori IgG antibodies were more common in colorectal polyp patients compared with either control group, the prevalence being 79% in cases compared with 62% in both control groups. The corresponding RR was 1.4 (0.76-2.6) compared with hospital controls and 2.1 (1.1-3.9) compared with population controls. After adjusting for possible confounding variables the association between H. pylori status and adenoma risk was even more marked. There was an RR of 1.6 (0.80-3.4) compared with hospital controls and an RR of 2.6 (1.3-5.4) compared with population controls, the latter association being statistically significant."

Breuer-Katschinski - Digestion 1999 abstract / PubMed

Helicobacter pylori infection increases the risk of colorectal adenoma and adenocarcinoma, especially in women. S Fujimori, T Kishida, T Kobayashi, Y Sekita, T Seo, K Nagata, A Tatsuguchi, K Gudis, K Yokoi, N Tanaka, K Yamashita, T Tajiri, Y Ohaki, C Sakamoto. J Gastroenterol 2005 Sep;40(9):887-893. 669 patients, "evaluated for H. pylori infection by (13)C-urea breath test, urease test, or histological diagnosis of biopsied gastric specimens." "Pooling all subjects, those infected with H. pylori had a significantly increased OR for adenoma, adenocarcinoma, or tumor, compared to H. pylori-free patients (OR, 1.60, 1.80, and 1.66, respectively). For female H. pylori-positive subjects, the risk of having adenocarcinoma or tumor was significantly higher than that for their H. pylori-free counterparts, while for male H. pylori-positive and -negative subjects, there was no such significant difference."

Fujimori - J Gastroenterol 2005 abstract / PubMed

Helicobacter pylori infection is associated with colon adenomatous polyps detected by high-resolution colonoscopy. S Mizuno, Y Morita, T Inui, A Asakawa, N Ueno, T Ando, H Kato, M Uchida, T Yoshikawa, A Inui. Int J Cancer 2005 Dec 20;117(6):1058-1059. 332 patients with routine colonoscopy and serologic testing. Previously treated or borderline were excluded. "A significant increase in the incidence of adenomatous polyps (p < 0.0001) and decrease in normal colonoscopic findings (p < 0.0005) were observed in seropositive patients than those seronegative."

Mizuno - Int J Cancer 2005 abstract / PubMed

Hypergastrinemia is associated with increased risk of distal colon adenomas. SD Georgopoulos, D Polymeros, K Triantafyllou, C Spiliadi, A Mentis, DG Karamanolis, SD Ladas. Digestion 2006;74(1):42-46. 78 consecutive patients and 78 controls. "Though prevalence of H. pylori antibodies was not significantly different, the prevalence of cagA protein was significantly higher in patients with adenomas (42.3%) as compared with controls (25.6%, p < 0.03). Mediangastrin levels were significantly higher in patients with CAs (55, 20-975 pg/ml) than in controls (45.2, 23-529 pg/ml) (p < 0.001). Hypergastrinemia (>110 pg/ml) was commoner in patients with CAs than in controls (29.5 vs. 11.5%, p = 0.006) and was the only independent risk factor for adenomas (odds ratio 3.2, 95% CI 1.4-7.5) by multivariate analysis, but not H. pylori infection or cagA positivity. There was a significant association of hypergastrinemia and distal distribution of adenomas (p < 0.002)."

Georgopoulos - Digestion 2006 abstract / PubMed

Gastrin and Colorectal Neoplasia: Cause and Effect. Y Niv. Digestion 2006;74(1):40-41. Editorial re Georgopoulos 2006.

Niv / Digestion 2006 full article (pdf, 2pp)

Helicobacter pylori infection and colorectal cancer risk: a meta-analysis. N Zumkeller, H Brenner, M Zwahlen, D Rothenbacher. Helicobacter 2006 Apr;11(2):75-80. In 11 studies between 1991 and 2002, "a summary odds ratio of 1.4 (95% CI, 1.1-1.8) was estimated for the association between H. pylori infection and colorectal cancer risk. The graphical funnel plot appeared asymmetrical, but the formal statistical evaluations did not provide strong evidence of publication bias."

Zumkeller - Helicobacter 2006 abstract / PubMed

Helicobacter pylori in colorectal neoplasms: is there an aetiological relationship? M Jones, P Helliwell, C Pritchard, J Tharakan, J Mathew. World J Surg Oncol 2007 May 12;5:51. Paraffin processed colonic tissue blocks of 60 normal colonic mucosa, 60 adenomas, and 60 adenocarcinomas. " Significant numbers of Helicobacter pylori were identified in tubular adenomas (OR = 11.13; 95%CI = 1.62-76.70), tubulovillous adenomas (OR = 10.45; 95%CI = 1.52-71.52) and adenocarcinomas (OR = 8.13; 95%CI = 1.40-46.99) compared to controls: there was no association in numbers of Helicobacter pylori and villous adenomas (OR = 2.95; 95%CI = 0.29-9.96)."

Jones - World J Surg Oncol 2007 full article / PubMed Central
Jones / World J Surg Oncol 2007 full article

Gastrin, Helicobacter pylori, and colorectal adenomas. DJ Robertson, RS Sandler, DJ Ahnen, ER Greenberg, LA Mott, BF Cole, JA Baron. Clin Gastroenterol Hepatol 2009 Feb;7(2):163-167. 685 subjects with a history of adenomas from 2 adenoma chemoprevention trials. "Gastrin levels were significantly higher in the 239 subjects with Hp titers indicating infection (mean, 88.3 pg/mL) than in those not infected (mean, 73.9 pg/mL; P < .001). In fully adjusted models, gastrin levels were not associated with incident adenoma development (risk ratio [RR], 1.10; 95% confidence interval [CI], 0.78-1.54) or advanced adenoma formation (RR, 0.82; 95% CI, 0.33-2.03). A positive Hp serology was associated with a decreased risk for adenoma formation (RR, 0.76; 95% CI, 0.60-0.96)." [Subjects may have included a large proportion with Familial Adenomatous Polyposis, whose adenomas are not associated with H. pylori infection -cast]

Robertson - Clin Gastroenterol Hepatol 2009 abstract / PubMed

Seroprevalence of Helicobacter pylori in patients with colon adenomas in a Brazilian university hospital. AG Buso, HL Rocha, DM Diogo, PM Diogo, A Diogo-Filho. Arq Gastroenterol 2009 Apr-Jun;46(2):97-101. 94 cases and 94 controls. "The H. pylori serology was positive for 66 (70.21%) of the cases and for 51 (54.25%) of the controls. There was a significant difference (P = 0.024). The odds ratio was 1.98 (CI 95%, 0.82-3.15). The prevalence of H. pylori in cases and controls according to gender, histological type and location of the colon lesions showed a significant difference only among women (P = 0.03), among patients with tubular adenomas (P = 0.03), and in those with distal adenomas (P = 0.038)."

Buso - Arq Gastroenterol 2009 abstract / PubMed

[Analysis of serum gastrin levels in patients with adenomatous polyps of the colon]. P Oset, A Jasińska, P Szcześniak, D Orszulak-Michalak, R Talar-Wojnarowska, E Małecka-Panas. Pol Merkur Lekarski 2009 May;26(155):458-461. 60 patients with adenomatous polyps of the colon and 30 healthy volunteers. "We observed higher serum gastrin levels in patients with colonic adenomas compared to control group (59.65 pg/ml vs. 46.89 pg/ml; p < 0.05). There was no association between gastrin levels and size, number, localisation and histologic type of polyps (p > 0.05). No differences between frequency of Helicobacter pylori infection and examined group of patients were observed (p > 0.05)."

Oset - Pol Merkur Lekarski 2009 abstract / PubMed

Gastric dysplasia may be an independent risk factor of an advanced colorectal neoplasm. RC Bae, SW Jeon, HJ Cho, MK Jung, YO Kweon, SK Kim. World J Gastroenterol 2009 Dec 7;15(45):5722-5726. 133 patients with gastric dysplasia, 213 controls. "No significant difference was found between the H pylori positive and negative subjects in terms of the prevalence of colorectal adenoma and advanced colorectal adenoma (P = 0.261). Patients with gastric dysplasia showed no elevated risk of colorectal adenoma (OR = 0.910, 95% CI: 0.587-1.411, P = 0.738), but had a significantly higher risk of having advanced colorectal adenoma (OR = 3.382, 95% CI: 1.700-6.342, P = 0.000)."

Bae - World J Gastroenterol 2009 full article / PubMed Central
Bae / World J Gastroenterol 2009 full article

Helicobacter pylori infection concomitant with metabolic syndrome further increase risk of colorectal adenomas. YL Lin, JK Chiang, SM Lin, CE Tseng. World J Gastroenterol 2010 Aug 14;16(30):3841-3846. 9311 healthy subjects. "The prevalence values for H. pylori infection, metabolic syndrome, and colorectal adenoma were 39.2%, 18.7%, and 20.7%, respectively. Colorectal adenoma risk factors included male gender [odd ratio (OR): 2.005, 95% confidence interval (CI): 1.740-2.310, P < 0.001], advanced age (OR: 1.046, 95% CI: 1.040-1.052, P < 0.001), smoking (OR: 1.377, 95% CI: 1.146-1.654, P = 0.001), increased body fat (OR: 1.016, 95% CI: 1.007-1.026, P = 0.001), higher white blood cell count (OR: 1.038, 95% CI: 1.005-1.073, P = 0.025), H. pylori infection (OR: 1.366, 95% CI: 1.230-1.517, P < 0.001), and metabolic syndrome (OR: 1.408, 95% CI: 1.231-1.610, P < 0.001). In addition, concomitant H. pylori infection with metabolic syndrome further increased the probability of colorectal adenomas."

Lin - World J Gastroenterol 2010 full article / PubMed Central
Lin / World J Gastroenterol 2010 full article

Association of Helicobacter pylori infection with the development of colorectal polyps and colorectal carcinoma. K Abbass, W Gul, G Beck, R Markert, S Akram. South Med J 2011 Jul;104(7):473-476. 192 patients, 96 HP-positive and 96 HP-negative. "Adenomatous colon polyps were noted in 31% of the HP-positive cases and in 26% of the HP-negative controls (P = 0.52). Colon carcinoma was found in 6% of HP-positive and 2% of HP-negative patients (P = 0.28)." Not statistically significant due to study size.

Abbass - South Med J 2011 abstract / PubMed

Elevated risk of colorectal adenoma with Helicobacter pylori-related chronic gastritis: a population-based case-control study. I Inoue, C Mukoubayashi, N Yoshimura, T Niwa, H Deguchi, M Watanabe, S Enomoto, T Maekita, K Ueda, M Iguchi, K Yanaoka, H Tamai, K Arii, M Oka, M Fujishiro, T Takeshita, M Iwane, O Mohara, M Ichinose. Int J Cancer 2011 Dec 1;129(11):2704-2711. 239 colorectal adenoma cases and 239 controls. "H. pylori infection was a risk factor for adenoma as a whole (crude odds ratio [OR]: 2.26, 95% confidence interval [CI]: 1.44-3.55). Analysis of distal adenoma cases showed that adenoma risk was significantly increased in the presence of H. pylori infection, but there was no further increase in risk with CAG. In contrast, proximal adenoma risk increased stepwise with the presence and progression of H. pylori-related chronic gastritis and showed a maximal and significant increase with CAG (crude OR: 4.51, 95% CI: 1.43-14.2). Subjects with more extensive and severe gastritis showed still higher risk not only for proximal but also for distal adenoma."

Inoue - Int J Cancer 2011 abstract / PubMed

Helicobacter pylori infection increases the risk of colorectal adenomas: cross-sectional study and meta-analysis. SN Hong, SM Lee, JH Kim, TY Lee, JH Kim, WH Choe, SY Lee, YK Cheon, IK Sung, HS Park, CS Shim. Dig Dis Sci 2012 Aug;57(8):2184-2194. 2,195 asymptomatic average-risk subjects who underwent screening colonoscopy and H. pylori testing. "In the H. pylori (+) group, the prevalence of colorectal adenoma and advanced adenoma was significantly higher than in the H. pylori (-) group (25.3 vs. 20.1 %, p = 0.004 and 6.1 vs. 2.9 %, p < 0.001, respectively). In our multivariate analysis, H. pylori seropositivity was an independent risk factor for overall colorectal adenoma (OR = 1.36, 95 % CI = 1.10-1.68) and advanced adenoma (OR = 2.21, 95 % CI = 1.41-3.48). The positive association was confined in cases with any proximal adenoma. In the meta-analysis, which included ten studies and 15,863 patients, the pooled OR for colorectal adenoma related to H. pylori infection was 1.58 (95 % CI = 1.32-1.88)."

Hong - Dig Dis Sci 2012 abstract / PubMed

Helicobacter pylori but not gastrin is associated with the development of colonic neoplasms. M Selgrad, J Bornschein, A Kandulski, C Hille, J Weigt, A Roessner, T Wex, P Malfertheiner. Int J Cancer 2014 Sep 1;135(5):1127-1131. 377 patients. "In H. pylori infected patients (n = 138; 36.6%), the overall prevalence of colonic neoplasms was more frequent compared to H. pylori negative patients (n = 239; 63.4%) (OR = 2.73, 95% CI: 1.76-4.24). H. pylori infection occurred more frequently in patients with hyperplastic polyps (OR = 2.66, 95% CI: 1.23-5.74) and adenomas presenting with low grade intraepithelial neoplasia (IEN) (OR = 1.85, 95% CI: 1.14-2.99)."

Selgrad - Int J Cancer 2014 abstract / PubMed

The association of H. pylori and colorectal adenoma: does it exist in the US Hispanic population? S Patel, S Lipka, H Shen, A Barnowsky, J Silpe, J Mosdale, Q Pan, S Fridlyand, A Bhavsar, A Abraham, P Viswanathan, P Mustacchia, B Krishnamachari. J Gastrointest Oncol 2014 Dec;5(6):463-468. [New York City area hispanics are not typical of the rest of U.S. - cast] 1642 colonoscopies. "H. pylori prevalence was highest in Hispanics [n=335] 40.9%, followed by Blacks [n=261] 29.1% (OR 0.59, 95% CI: 0.42-0.84), then Whites [n=140] 7.9% (OR 0.12, 95% CI: 0.06-0.24). The adenoma detection rate was significantly higher in Whites 23.2% and Blacks 21.8% compared to Hispanics 14.5%, P=0.0002 respectively. Smoking and alcohol were lower in the H. pylori group, 18.6% (n=44) vs. 26.1% (n=147) for smoking (P=0.02) and 14.4% (n=34) vs. 19% (n=107) for alcohol (P=0.12), respectively. There was no evidence in the Hispanics for an association between adenoma detection and H. pylori infection." Also, "Most of our patients were South American."

Patel - J Gastrointest Oncol 2014 full article / PubMed Central

Combination of Triple Therapy and Chronic PPI Use May Decrease Risk of Colonic Adenomatous Polyps in Helicobacter pylori Infection. R Zuniga, J Bautista, K Sapra, K Westerfield, S Williams, AM Sy. Gastroenterol Res Pract 2015;2015:638547. 943 colonoscopy patients. "H. pylori was associated with increased odds of colonic adenomatous polyps (adjusted OR 1.43, 95% CI 1.04-1.77), with stronger association among patients older than 50 (OR 1.65, 95% CI 1.18-2.33). Triple therapy (OR 0.69, 95% CI 0.44-1.07) or chronic PPI use (OR 0.69, 95% CI 0.43-1.09) decreased odds of polyp formation. Analysis revealed a statistically significant reduction in patients who received both triple therapy and chronic PPI, lowering the odds by 60% (adjusted OR 0.43, 95% CI 0.27-0.67)."

Zuniga - Gastroenterol Res Pract 2015 full article / PubMed Central
Zuniga / Gastroenterol Res Pract 2015 full article

See Also:

Helicobacter pylori causes ulcers and stomach cancer
Helicobacter is Implicated in Pancreatic Cancer
JC Polyoma Virus Causes Colon Cancer


cast 06-24-15