title: Elevated risk of colorectal adenoma with Helicobacter pylori-related chronic gastritis: a population-based case-control study.
abstract: This study investigated correlations between Helicobacter pylori infection or chronic atrophic gastritis (CAG) and risk of colorectal adenoma in a population-based case-control study. Subjects comprised asymptomatic, middle-aged, male Japanese factory workers who participated in an annual health check-up program, including cancer screening with colonoscopy. We selected 239 colorectal adenoma cases based on histological evaluation and 239 age-matched adenoma-free controls, and evaluated colorectal adenoma risk according to stage of H. pylori-related chronic gastritis as determined by serum tests for H. pylori antibody titer and pepsinogen. Subjects with colorectal adenoma were more likely to be smokers and have hypercholesterolemia. 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. H. pylori-related chronic gastritis is likely to be involved in the development of colorectal neoplasms, and its progression appears to increase the risk, particularly for proximal adenomas. Knowing the H. pylori-related chronic gastritis stage will probably be useful for evaluation of risk for colorectal neoplasia.
authors.affiliation: Department of Gastroenterology, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, Japan. izumiino@wakayama-med.ac.jp
authors.forename: Izumi
authors.initials: I
authors.lastname: Inoue
authors.forename: Chizu
authors.initials: C
authors.lastname: Mukoubayashi
authors.forename: Noriko
authors.initials: N
authors.lastname: Yoshimura
authors.forename: Tohru
authors.initials: T
authors.lastname: Niwa
authors.forename: Hisanobu
authors.initials: H
authors.lastname: Deguchi
authors.forename: Mika
authors.initials: M
authors.lastname: Watanabe
authors.forename: Shotaro
authors.initials: S
authors.lastname: Enomoto
authors.forename: Takao
authors.initials: T
authors.lastname: Maekita
authors.forename: Kazuki
authors.initials: K
authors.lastname: Ueda
authors.forename: Mikitaka
authors.initials: M
authors.lastname: Iguchi
authors.forename: Kimihiko
authors.initials: K
authors.lastname: Yanaoka
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Tamai
authors.forename: Kenji
authors.initials: K
authors.lastname: Arii
authors.forename: Masashi
authors.initials: M
authors.lastname: Oka
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Fujishiro
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Takeshita
authors.forename: Masataka
authors.initials: M
authors.lastname: Iwane
authors.forename: Osamu
authors.initials: O
authors.lastname: Mohara
authors.forename: Masao
authors.initials: M
authors.lastname: Ichinose
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology / Q000209:etiology*; D000236:Adenoma / Q000453:epidemiology / Q000209:etiology*; D000328:Adult; D016022:Case-Control Studies; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000453:epidemiology / Q000209:etiology*; D005500:Follow-Up Studies; D005757:Gastritis, Atrophic / Q000150:complications* / Q000821:virology; D016481:Helicobacter Infections / Q000150:complications* / Q000821:virology; D016480:Helicobacter pylori / Q000472:pathogenicity*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D011795:Surveys and Questionnaires; D015996:Survival Rate