Helicobacter pylori Infection and the Development of Advanced Colorectal Neoplasia.

Background: An association betweenHelicobacter pyloriinfection and colorectal neoplasia has been reported in cross-sectional studies. Goals: We examined the association betweenH. pyloriinfection and the development of advanced colorectal neoplasia (AN) in a screening cohort. Study: We identified 3753 adults, who underwent screening and subsequent surveillance colonoscopies. The primary outcome was the development of metachronous AN, as confirmed by surveillance colonoscopy.H. pyloriinfection status was assessed by anH. pylori-specific immunoglobulin G antibody test. Sensitivity analysis was also performed byH. pyloriinfection status on the basis of histology. Results: During a median follow-up of 41 months, the incidence of AN was 3.2% and 1.7% in participants with and withoutH. pyloriinfection, respectively. In multivariable analysis adjusted for age, body mass index, smoking status, alcohol intake, family history of colorectal cancer, and baseline adenoma characteristics, the hazard ratio [95% confidence interval (CI)] for metachronous AN was 1.74 (1.11-2.73) in participants withH. pyloriseropositivity, compared with those withoutH. pyloriseropositivity. The association was consistent withH. pyloriinfection status on the basis of histology (adjusted hazard ratio, 3.51; 95% CI, 1.64-7.51). In the subgroup analysis, the positive association was observed in both no-adenoma and adenoma removal subgroups. Conclusions: In a cohort study,H. pyloriinfection was associated with an increased risk of AN development. This association was consistent in both the serological and histologic assessment ofH. pyloriinfection. Prospective studies are necessary to determine whetherH. pylorieradication can reduce the risk of colorectal neoplasia.