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. 2024 Jun 1;42(16):1881-1889.
doi: 10.1200/JCO.23.00703. Epub 2024 Mar 1.

Impact of Helicobacter pylori Infection and Treatment on Colorectal Cancer in a Large, Nationwide Cohort

Shailja C Shah  1   2 , M Constanza Camargo  3 , Mark Lamm  1 , Ranier Bustamante  1   2 , Christianne L Roumie  4   5   6 , Otis Wilson  4 , Alese E Halvorson  7 , Robert Greevy  7 , Lin Liu  8 , Samir Gupta  1   2 , Joshua Demb  2
Affiliations

Impact of Helicobacter pylori Infection and Treatment on Colorectal Cancer in a Large, Nationwide Cohort

Shailja C Shah et al. J Clin Oncol. .

Abstract

Purpose: Helicobacter pylori is the most common cause of infection-associated cancer worldwide. We aimed to evaluate the impact of H. pylori infection and treatment on colorectal cancer (CRC) incidence and mortality.

Patients: US Veterans who completed H. pylori testing between 1999 and 2018.

Methods: We conducted a retrospective cohort analysis among adults within the Veterans Health Administration who completed testing for H. pylori. The primary exposures were (1) H. pylori test result (positive/negative) and (2) H. pylori treatment (untreated/treated) among H. pylori-positive individuals. The primary outcomes were CRC incidence and mortality. Follow-up started at the first H. pylori testing and continued until the earliest of incident or fatal CRC, non-CRC death, or December 31, 2019.

Results: Among 812,736 individuals tested for H. pylori, 205,178 (25.2%) tested positive. Being H. pylori-positive versus H. pylori-negative was associated with higher CRC incidence and mortality. H. pylori treatment versus no treatment was associated with lower CRC incidence and mortality (absolute risk reduction 0.23%-0.35%) through 15-year follow-up. Being H. pylori-positive versus H. pylori-negative was associated with an 18% (adjusted hazard ratio [adjusted HR], 1.18 [95% CI, 1.12 to 1.24]) and 12% (adjusted HR, 1.12 [95% CI, 1.03 to 1.21]) higher incident and fatal CRC risk, respectively. Individuals with untreated versus treated H. pylori infection had 23% (adjusted HR, 1.23 [95% CI, 1.13 to 1.34]) and 40% (adjusted HR, 1.40 [95% CI, 1.24 to 1.58]) higher incident and fatal CRC risk, respectively. The results were more pronounced in the analysis restricted to individuals with nonserologic testing.

Conclusion: H. pylori positivity may be associated with small but statistically significant higher CRC incidence and mortality; untreated individuals, especially those with confirmed active infection, appear to be most at risk.

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Conflict of interest statement

Conflicts of Interest and Financial Disclosures: All authors report no conflicts of interest that are relevant to this article. Shailja C. Shah serves as an ad hoc consultant and advisor for Phathom Pharmaceuticals and ad hoc consultant for RedHill Biopharma.

Figures

Figure 1.
Figure 1.. Flow diagram illustrating analytic cohort construction.
Figure 2A-2B.
Figure 2A-2B.. Colorectal cancer cumulative incidence curves among A) individuals testing positive vs. negative for H. pylori; and B) individuals testing positive for H. pylori who were treated vs. untreated.
(A) Compared to H. pylori negative individuals, H. pylori positive individuals had a significantly higher cumulative CRC incidence, and (B) among H. pylori positive individuals, those who were treated had significantly lower cumulative CRC incidence compared to those who were not treated. Log-rank p-value for both plots <0.001
Figure 2A-2B.
Figure 2A-2B.. Colorectal cancer cumulative incidence curves among A) individuals testing positive vs. negative for H. pylori; and B) individuals testing positive for H. pylori who were treated vs. untreated.
(A) Compared to H. pylori negative individuals, H. pylori positive individuals had a significantly higher cumulative CRC incidence, and (B) among H. pylori positive individuals, those who were treated had significantly lower cumulative CRC incidence compared to those who were not treated. Log-rank p-value for both plots <0.001
See this image and copyright information in PMC

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