Helicobacter pylori infection and the risk of colorectal cancer: a nationwide population-based cohort study

Abstract

Background The role of Helicobacter pylori (H. pylori) infection in the development of colorectal neoplasia has been a matter of scientific debate with controversial findings. Aims This study examined the association between H. pylori infection and colorectal cancer (CRC) in a nationwide population-based Chinese cohort study. Methods A total of approximately 3936 individuals with newly diagnosed H. pylori infection (the H. pylori-infected cohort) and 15 744 age- and sex-matched patients with diagnoses absence of H. pylori infection (the comparison cohort) from 2000 to 2005 were identified from Taiwan’s National Health Insurance Research Database. The Kaplan–Meier method was used for measuring the cumulative incidence of CRC in each cohort. Cox proportional hazards models were used to compute hazard ratios (HRs) and accompanying 95% confidence intervals (CIs) for the estimation of the association between H. pylori infection and CRC. Results The cumulative incidence of CRC was higher in H. pylori-infected cohort than that in the comparison cohort (log-rank test, P < 0.001). After adjustment for potential confounders, H. pylori infection was associated with a significantly increased risk of CRC (adjusted HR 1.87; 95% CI 1.37–2.57). In addition, the HR of CRC appeared to increase with increasing frequency of clinical visits for H. pylori infection. Conclusions Our study demonstrated that H. pylori infection was associated with an increased risk of CRC, which warrants confirmation and exploration of the underlying biologic mechanisms by future studies.

H. pylori Infection and Colorectal Cancers by Anatomical Locations

“…Our findings are consistent with the results of the positive association between serologic responses to H. pylori proteins and CRC (Butt et al, 2019;Epplein et al, 2013). The results are also consistent with the recent Meta-analyses confirmed the positive association between H. pylori infection and the development of CRC (Chen et al, 2013;Guo & Li, 2014;Hong et al, 2012;Rokkas et al, 2013;Wu et al, 2013;Yang et al, 2019;Zhao et al, 2016;Zhao et al, 2008;Zumkeller et al, 2006), and the findings of the original study in Germany (Zhang et al, 2012), in Korea (Park et al, 2018), and China (Liu et al, 2019). The available Meta-analysis by 2019 has not examined for the subgroups of distal and rectum cancers combined.…”

“…Although results from the previous studies on the association between H. pylori infection and CRC are inconsistent. This inconsistency could be attributable to the quality of the previous observational studies when the data related to the CRC of diet and nutrition and smoking status (IARC, 1986) was not included as confounding factor adjustment in the data analysis due to their limitation of the available database (Butt et al, 2019;Epplein et al, 2013;Liu et al, 2019;Park et al, 2018;Strofilas et al, 2012;Teimoorian et al, 2018).…”

Risk for Irritable Bowel Syndrome in Patients with Helicobacter Pylori Infection: A Nationwide Population-Based Study Cohort Study in Taiwan

“…pylori can produce bacterial urease, which hydrolyses in gastric luminal urea to form ammonia, which helps neutralize gastric acid and form a protective cloud around the organism, enabling it to penetrate the gastric mucus layer [25]. Several studies have reported an association between H. pylori infection and the incidence of gastric cancer and colorectal cancer [26,27]. Diagnostic testing for H. pylori includes endoscopic biopsy urease testing, urea breath testing, stool antigen assay, and serological ELISA testing [28].…”

Gut Microbiota Profiles in Early- and Late-Onset Colorectal Cancer: A Potential Diagnostic Biomarker in the Future

“…Kumar et al [80] in 2017 studied that S. gallolyticus promoted cell proliferation and CRC development by increasing β-catenin signaling. A cohort study from Taiwan's National Health Insurance Research Database found that Helicobacter pylori infection was associated with increased risk of CRC (HR 1.87; 95% CI 1.37-2.57) [81]. Hypergastrinemia from chronic H. pylori infection leads to a mutagenesis.…”