H. pylori colonic neoplasm link confirmed

Helicobacter pylori gastritis is significantly associated with colonic neoplasms, show the results of one of the largest studies of the association to date.

The study also showed that other types of H. pylori infection-related conditions, such as gastric cancer were associated with an increased risk for neoplasm.

"The risk applies to all types of colonic neoplasm and appears to increase with advancing stage of the neoplasm," say Amnon Sonnenberg (Oregon Health and Science University, Portland, USA) and Robert Genta (University of Texas Southwestern Medical Center, Dallas, USA).

The study included 156,269 patients who underwent both colonoscopy and esophago-gastro-duodenoscopy.

Sonnenberg and colleagues found that patients with hyperplastic polyps had a 24% increased odds for H. pylori gastritis compared with patients with no polyps (11 vs 9%). The odds for H. pylori gastritis increased with the stage of the neoplasm such that they were 52% greater in patients with adenoma, and 235% greater in patients with adenocarcinoma compared with patients with no polyps (12 and 18 vs 9%).

Additionally, the strength of the association significantly increased with the size and numbers of adenomas. For example, patients with 10 or more adenomas had a 3.4-fold increased odds for H. pylori gastritis compared with patients with no polyps (19 vs 9%), while patients with 1-2 adenomas had a 1.5-fold increased odds (12 vs 9%).

However, there was no association between the location of polyps and H. pylori.

The authors also found that the risk for colonic neoplasms was associated with other pathologies such as gastric intestinal metaplasia, gastric adenoma, gastric lymphoma, and gastric cancer but other, H. pylori-negative conditions showed a weak association with colonic neoplasms.

Writing in the American Journal of Gastroenterology, Sonnenberg and colleagues say that in the past, H. pylori likely made a substantial contribution toward colorectal cancer rates.

"From a public health perspective, H. pylori and the recent decline of its infection rate may have affected the occurrence of colorectal cancer in western populations more profoundly than any medical intervention," they conclude.

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