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Increased risk of colorectal cancer is observed in patients with a history of Helicobacter pylori infection.

Multiple modifiable and non-modifiable factors are associated with an increased risk of colorectal cancer (CRC), such as obesity, alcohol consumption, smoking, inflammatory bowel disease, and a family history of CRC. Helicobacter pylori (H. pylori) is the most common bacterial infection worldwide and the strongest risk factor for gastric cancer. However, only limited research is available on the association of this infection with the risk of developing CRC. A study in the Annals of Gastroenterology provides the first evidence from large population-based research regarding the association between CRC risk and a history of H. pylori infection.

Demographic and Risk Factors in Colorectal Cancer Patients and Controls

Approximately 47.7 million individuals were included in the study, selected from a database of more than 360 hospitals and spanning 20 years. Of these, 82,420 were CRC patients, and approximately 47.6 million were controls, with 56.83% of the patients being female. The prevalence of CRC increased with age in all ethnic groups. Hispanic and Asian patients had an earlier peak in prevalence.

Caucasian and Asian race, hyperlipidemia, type 2 diabetes mellitus, obesity, irritable bowel syndrome, smoking, alcohol use, and a positive serological test for H. pylori infection were more common in patients with CRC compared to controls.

High-Risk Factors and Predictors for Colorectal Cancer

Univariate regression analysis of risk factors demonstrated that the risk of CRC was greater in smokers (odds ratio (OR) 3.65, 95% confidence interval (CI) 3.30–3.42), obese patients (OR 3.70, 95% CI 3.63–3.76), individuals with irritable bowel syndrome (OR 3.19, 95% CI 3.07–3.32), type 2 diabetes mellitus patients (OR 4.60, 95% CI 4.52–4.69), and patients with a history of H. pylori infection (OR 3.92, 95% CI 3.52–4.36).

Multivariate Regression Analysis of Risk and Predictors of Colorectal Cancer

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A multivariate regression analysis was performed to adjust for confounding variables. The risk of CRC was greater in smokers (OR 2.52, 95% CI 2.47–2.57), obese patients (OR 2.26, 95% CI 2.22–2.30), patients with irritable bowel syndrome (OR 2.02, 95% CI 1.94–2.09), type 2 diabetes mellitus patients (OR 2.89, 95% CI 2.84–2.95), and individuals with a history of H. pylori infection (OR 1.89, 95% CI 1.69–2.10).

In conclusion, the study demonstrates an independent positive association between a history of H. pylori infection and the risk of CRC. Additional large-scale studies are needed to establish this association and a causal link.


Boustany, A. (2023). Epidemiology and risk of colorectal cancer in patients with a history of Helicobacter pylori infection: a population-based study. Annals of Gastroenterology. https://doi.org/10.20524/aog.2023.0783