title: Elevated risk of recurrent colorectal neoplasia withHelicobacter pylori-associated chronic atrophic gastritis: A follow-up study of patients with endoscopically resected colorectal neoplasia.
abstract: In a previous population-based case-control study, we demonstrated an elevated risk of colorectal neoplasia withHelicobacter pylori(H. pylori) infection. The present study investigated the effects ofH. pylori-associated chronic gastritis on the development of colorectal neoplasia by analyzing the recurrence of colorectal neoplasia subsequent to endoscopic resection. Ninety-nine patients who had undergone endoscopic resection of colorectal neoplasia were monitored under colonoscopy, and the recurrence of colorectal neoplasia was prospectively investigated. The stage ofH. pylori-associated chronic gastritis in each subject was evaluated using a combination of two serum tests:H. pyloriantibody and pepsinogen. In the present cohort, colorectal neoplasia recurred at a rate of 15,296/100,000 person-years during the study period. After adjusting for the confounding factors, chronic atrophic gastritis (CAG) was identified as an independent risk factor [adjusted hazard ratio (HR), 2.72; 95% confidence interval, 1.33-5.57], whileH. pylori-infected non-atrophic gastritis was not identified as an independent risk factor for recurrent colorectal neoplasia. Colorectal neoplasia recurred earlier and was significantly more frequent in patients with CAG (22,573/100,000 person-years) compared to patients without CAG (11,089/100,000 person-years; P=0.029, log-rank test). Patients with more extensive CAG showed a higher risk of recurrence. These results demonstrated a significant elevation of the risk of recurrent colorectal neoplasia with the establishment and progression of CAG, indicating the involvement ofH. pyloriinfection in the development of colorectal neoplasia. The two serum tests were useful clinical markers for noninvasively evaluating the risk of each individual for recurrent colorectal neoplasia subsequent to endoscopic resection.
authors.affiliation: Department of Gastroenterology, School of Medicine, Wakayama Medical University, Wakayama 641-0012;
authors.forename: Izumi
authors.initials: I
authors.lastname: Inoue
authors.affiliation: Department of Gastroenterology, School of Medicine, Wakayama Medical University, Wakayama 641-0012;
authors.forename: Jun
authors.initials: J
authors.lastname: Kato
authors.affiliation: Departments of Joint Disease Research and.
authors.forename: Noriko
authors.initials: N
authors.lastname: Yoshimura
authors.affiliation: Department of Gastroenterology, School of Medicine, Wakayama Medical University, Wakayama 641-0012;
authors.forename: Yoshimasa
authors.initials: Y
authors.lastname: Maeda
authors.affiliation: Department of Gastroenterology, School of Medicine, Wakayama Medical University, Wakayama 641-0012;
authors.forename: Kosaku
authors.initials: K
authors.lastname: Moribata
authors.affiliation: Department of Gastroenterology, School of Medicine, Wakayama Medical University, Wakayama 641-0012;
authors.forename: Naoki
authors.initials: N
authors.lastname: Shingaki
authors.affiliation: Department of Gastroenterology, School of Medicine, Wakayama Medical University, Wakayama 641-0012;
authors.forename: Hisanobu
authors.initials: H
authors.lastname: Deguchi
authors.affiliation: Department of Gastroenterology, School of Medicine, Wakayama Medical University, Wakayama 641-0012;
authors.forename: Shotaro
authors.initials: S
authors.lastname: Enomoto
authors.affiliation: Department of Gastroenterology, School of Medicine, Wakayama Medical University, Wakayama 641-0012;
authors.forename: Takao
authors.initials: T
authors.lastname: Maekita
authors.affiliation: Department of Gastroenterology, School of Medicine, Wakayama Medical University, Wakayama 641-0012;
authors.forename: Kazuki
authors.initials: K
authors.lastname: Ueda
authors.affiliation: Department of Gastroenterology, School of Medicine, Wakayama Medical University, Wakayama 641-0012;
authors.forename: Mikitaka
authors.initials: M
authors.lastname: Iguchi
authors.affiliation: Department of Gastroenterology, School of Medicine, Wakayama Medical University, Wakayama 641-0012;
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Tamai
authors.affiliation: Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655;
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Fujishiro
authors.affiliation: Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655;
authors.forename: Nobutake
authors.initials: N
authors.lastname: Yamamichi
authors.affiliation: Department of Public Health, School of Medicine, Wakayama Medical University, Wakayama 641-0012, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Takeshita
authors.affiliation: Department of Gastroenterology, School of Medicine, Wakayama Medical University, Wakayama 641-0012;
authors.forename: Masao
authors.initials: M
authors.lastname: Ichinose
keywords: chronic atrophic gastritis; cohort study; colorectal neoplasia; pepsinogen; recurrence