Research On The Association Between Helicobacter Pylori Related Gastric Diseases And Colorectal Neoplasm

Background and ObjectiveHelicobacter pylori are listed as class I carcinogen of gastric cancer by the international agency for research on cancer (IARC) which is affiliated to the world health organization. It is the main risk factor for sporadic gastric cancer, including both the intestinal type and the diffuse type. Recently, however, accumulating evidences indicate that H. pylori infection is not only a main risk factor in the gastric cancer, but also related to many neoplasms outside the stomach cancer. The relationship between H. pylori infection and the colorectal neoplasm, hepatic neoplasm and pancreas neoplasm has become the research hot spot in recent years. Among those, colorectal polyps and colorectal cancer are of special concern.The correlation between H. pylori and colorectal tumor was first reported in 1997. Many related studies have been conducted in recent years, both at home and abroad. However, the results vary widely. Most findings support that H. pylori infection is a risk factor for colorectal tumor lesions (including colorectal adenomas and colorectal cancer), while others indicate that H. pylori infection is not an important risk factor for colorectal adenocarcinoma.Based on these previous studies, we intend to explore the association between Helicobacter pylori related gastric diseases and colorectal neoplasm through the analysis of endoscopic and pathological data of patients who had a colonoscopy and esophago-gastro-duodenoscopy (EGD).Methods1. Patients selection:Patients included in this study had a colonoscopy and EGD with histopathological results between March 2012 and March 2015 at Qilu Hospital of Shandong University, who also had results of Helicobacter pylori detection.233 cases were selected.2. Collection of endoscopic and pathological data:Demographic data, Helicobacter pylori infection status (including results of rapid urease tests and gastric mucosa pathological examinations) and histopathological examination results of gastric and colorectal mucosa were gathered and analyzed.3. Statistical analysis:The statistical analysis was carried out using Excel 2013 and the statistical software of SPSS 20.0. The analysis was focused on the prevalence of colorectal neoplasm among patients with various histopathological categories of the stomach. Odds ratios and their 95% confidence intervals were calculated to describe the strengths of the associations. P< 0.05 indicates statistically significant.Results1. Colorectal adenomatous polyps without high-grade intraepithelial neoplasia (OR=2.400), colorectal adenomatous polyps with high-grade intraepithelial neoplasia (OR=5.333) and colorectal adenocarcinoma (OR=1.455) were all found more frequently among patients with Helicobacter pylori gastritis than patients with Helicobacter pylori-negative gastritis.2. Colorectal adenomatous polyps with high-grade intraepithelial neoplasia (OR=3.218) were found more frequently among patients with intestinal metaplasia than patients with Helicobacter pylori-negative gastritis, while colorectal adenomatous polyps without high-grade intraepithelial neoplasia (OR=0.874) and colorectal adenocarcinoma (OR=0.376) were found less frequently among patients with intestinal metaplasia than patients with Helicobacter pylori-negative gastritis.3. Colorectal adenomatous polyps without high-grade intraepithelial neoplasia (OR=3.111) were found significantly more frequently among patients with gastric intraepithelial neoplasia than patients with Helicobacter pylori-negative gastritis. Colorectal adenomatous polyps with high-grade intraepithelial neoplasia (OR= 1.481) and colorectal adenocarcinoma (OR=2.020) were also found more frequently among patients with gastric intraepithelial neoplasia than patients with Helicobacter pylori-negative gastritis.4. Colorectal adenomatous polyps without high-grade intraepithelial neoplasia (OR= 1.067), colorectal adenomatous polyps with high-grade intraepithelial neoplasia (OR=2.667) and colorectal adenocarcinoma (OR=2.182) were all found more frequently among patients with gastric adenocarcinoma than patients with Helicobacter pylori-negative gastritis.ConclusionHelicobacter pylori infection is a potential risk factor for colorectal neoplasm. Helicobacter pylori-related gastric diseases may be related to colorectal neoplasm.