Helicobacter Pylori Eradication Therapy and the Risk of Colorectal Cancer: A Population-Based Nationwide Cohort Study in Sweden

Overview

Journal Helicobacter

Specialty Microbiology

Date 2024 Nov 20

PMID 39567356

Authors

Qing Liu

Omid Sadr-Azodi

Lars Engstrand

Katja Fall

Nele Brusselaers

Affiliations

Soon will be listed here.

Abstract

Background: Helicobacter pylori (H. pylori) is an established gastric carcinogen, also associated with an increased risk of colorectal cancer. Therefore, we suspected that H. pylori eradication lowers the risk of colorectal cancer.

Material And Methods: We assessed if H. pylori eradication therapy is associated with a reduced risk of colorectal adenocarcinoma in a population-based nationwide cohort study. This study included all Swedish adults with at least one recorded H. pylori eradication episode between July 2005 and December 2012, based on the high-quality Swedish health registries. Colorectal adenocarcinoma risks were compared to the Swedish background population, presented as standardized incidence ratios (SIRs) and 95% confidence intervals (CIs), accounting for age, sex, calendar period, tumor location (left or right sided), stage, and number of eradication episodes, from 1 year after eradication and onward.

Results: Among 80,381 individuals receiving H. pylori eradication therapy (average follow-up 4.1 years), 282 were diagnosed with colorectal cancer (97.2% adenocarcinoma). Overall, H. pylori eradication was associated with an elevated risk of colorectal adenocarcinoma (SIR 1.27, 95% CI: 1.12-1.43). The colorectal adenocarcinoma risk was increased 1-2 years after eradication (SIR 1.42, 95% CI: 1.17-1.72), then decreased 2-4 years (SIR 0.80, 95% CI: 0.65-0.98) and 4-6 years (SIR 0.76, 95% CI: 0.57-0.99), yet not ≥ 6 years (SIR 1.36, 95% CI: 0.78-2.21) after eradication compared to the general population. Overall, right-sided (SIR 1.47, 95% CI: 1.21-1.76) and left-sided (SIR 1.35, 95% CI: 1.09-1.67) colon adenocarcinomas risks were higher among eradicated individuals than the general population.

Conclusion: H. pylori eradication was not associated with a clear and consistent reduction of colorectal cancer in our Swedish cohort.

References

Mik M, Berut M, Dziki L, Trzcinski R, Dziki A . Right- and left-sided colon cancer - clinical and pathological differences of the disease entity in one organ. Arch Med Sci. 2017; 13(1):157-162. PMC: 5206358. DOI: 10.5114/aoms.2016.58596. View

Liang Y, Zhang N, Wang M, Liu Y, Ma L, Wang Q . Distributions and Trends of the Global Burden of Colorectal Cancer Attributable to Dietary Risk Factors over the Past 30 Years. Nutrients. 2024; 16(1). PMC: 10780867. DOI: 10.3390/nu16010132. View

Chen C, Liou J, Lee Y, Hong T, El-Omar E, Wu M . The interplay between and gastrointestinal microbiota. Gut Microbes. 2021; 13(1):1-22. PMC: 8096336. DOI: 10.1080/19490976.2021.1909459. View

Liu K, Wang Y, Wang J, Chen B, Luo N, Gong J . Meta-analysis of proton pump inhibitor use and the risk of developing gastric cancer or colorectal cancer. Anticancer Drugs. 2023; 34(9):971-978. DOI: 10.1097/CAD.0000000000001418. View

Guo C, Zhang F, Jiang F, Wang L, Chen Y, Zhang W . Long-term effect of eradication on colorectal cancer incidences. Therap Adv Gastroenterol. 2023; 16:17562848231170943. PMC: 10164860. DOI: 10.1177/17562848231170943. View

von Elm E, Altman D, Egger M, Pocock S, Gotzsche P, Vandenbroucke J . The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007; 370(9596):1453-7. DOI: 10.1016/S0140-6736(07)61602-X. View

Chen Y, Malfertheiner P, Yu H, Kuo C, Chang Y, Meng F . Global Prevalence of Helicobacter pylori Infection and Incidence of Gastric Cancer Between 1980 and 2022. Gastroenterology. 2024; 166(4):605-619. DOI: 10.1053/j.gastro.2023.12.022. View

Zhu F, Zhang X, Li P, Zhu Y . Effect of Helicobacter pylori eradication on gastric precancerous lesions: A systematic review and meta-analysis. Helicobacter. 2023; 28(6):e13013. DOI: 10.1111/hel.13013. View

Wang J, Liang X, Xu J, Chen Y, Fang J . Helicobacter Pylori Infection Increases the Risk of Colorectal Adenomas: an Updated Meta-Analysis. Clin Lab. 2018; 64(7):1163-1170. DOI: 10.7754/Clin.Lab.2018.180115. View

10.

Murakami K, Matsubara H . Chronology of gastrointestinal cancer. Surg Today. 2017; 48(4):365-370. PMC: 5845061. DOI: 10.1007/s00595-017-1574-y. View

11.

Wu Y, Shi L, Li Q, Wu J, Peng W, Li H . Microbiota Diversity in Human Colorectal Cancer Tissues Is Associated with Clinicopathological Features. Nutr Cancer. 2019; 71(2):214-222. DOI: 10.1080/01635581.2019.1578394. View

12.

Baran B, Mert Ozupek N, Yerli Tetik N, Acar E, Bekcioglu O, Baskin Y . Difference Between Left-Sided and Right-Sided Colorectal Cancer: A Focused Review of Literature. Gastroenterology Res. 2018; 11(4):264-273. PMC: 6089587. DOI: 10.14740/gr1062w. View

13.

Leung W, Cheung K, Sham P, Tang R, Loo C, Hsu A . Consensus recommendations for the screening, diagnosis, and management of infection in Hong Kong. Hong Kong Med J. 2023; 29(6):532-541. DOI: 10.12809/hkmj2210321. View

14.

Vogel J, Felder S, Bhama A, Hawkins A, Langenfeld S, Shaffer V . The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Colon Cancer. Dis Colon Rectum. 2021; 65(2):148-177. DOI: 10.1097/DCR.0000000000002323. View

15.

Morgan E, Arnold M, Gini A, Lorenzoni V, Cabasag C, Laversanne M . Global burden of colorectal cancer in 2020 and 2040: incidence and mortality estimates from GLOBOCAN. Gut. 2023; 72(2):338-344. DOI: 10.1136/gutjnl-2022-327736. View

16.

Simin J, Fornes R, Liu Q, Olsen R, Callens S, Engstrand L . Antibiotic use and risk of colorectal cancer: a systematic review and dose-response meta-analysis. Br J Cancer. 2020; 123(12):1825-1832. PMC: 7722751. DOI: 10.1038/s41416-020-01082-2. View

17.

Jiang Z, Li L, Chen J, Wei G, Ji Y, Chen X . Human gut-microbiome interplay: Analysis of clinical studies for the emerging roles of diagnostic microbiology in inflammation, oncogenesis and cancer management. Infect Genet Evol. 2021; 93:104946. DOI: 10.1016/j.meegid.2021.104946. View

18.

Zuo Y, Jing Z, Bie M, Xu C, Hao X, Wang B . Association between Helicobacter pylori infection and the risk of colorectal cancer: A systematic review and meta-analysis. Medicine (Baltimore). 2020; 99(37):e21832. PMC: 7489651. DOI: 10.1097/MD.0000000000021832. View

19.

Breslow N, Day N . Statistical methods in cancer research. Volume II--The design and analysis of cohort studies. IARC Sci Publ. 1987; (82):1-406. View

20.

Chey W, Leontiadis G, Howden C, Moss S . ACG Clinical Guideline: Treatment of Helicobacter pylori Infection. Am J Gastroenterol. 2017; 112(2):212-239. DOI: 10.1038/ajg.2016.563. View