Brim Hassan, Zahaf Marwah, Laiyemo Adeyinka O, Nouraie Mehdi, Pérez-Pérez Guillermo I, Smoot Duane T, Lee Edward, Razjouyan Hadie, Ashktorab Hassan
Department of Medicine and Cancer Center, Howard University, Washington, DC, USA.
BMC Cancer. 2014 Apr 28;14:296. doi: 10.1186/1471-2407-14-296.
Gastric Helicobacter pylori (H. pylori) infection and colorectal polyps are more prevalent in African Americans than in the general population. We aimed to investigate whether gastric H. pylori infection is associated with colorectal polyps in African Americans.
Medical records of African Americans, 40 years and older (n = 1256) who underwent bidirectional gastrointestinal endoscopy on the same day were reviewed. H. pylori status was assessed by immunohistochemistry on gastric specimens. Colorectal polyps were confirmed by histological examination of colorectal biopsies. A subset of serum samples from healthy and polyp-bearing patients (n = 163) were analyzed by ELISA for anti-H. pylori and anti-CagA antibodies. The crude and adjusted effect of H. pylori on the risk of colorectal adenoma and polyp were computed by logistic regression models.
The prevalence of colorectal polyps and adenomas were 456 (36%) and 300 (24%) respectively. Colorectal polyps were more prevalent in gastric H. pylori infected than non-infected subjects [43% vs. 34%; Odds Ratio (OR) (95% CI): 1.5 (1.2-1.9), P = 0.001]. Patients with H. pylori-associated chronic active gastritis were at high risk to have adenomas [Unadjusted OR (95% CI): 1.3 (1.0-1.8); P = 0.04]. There was no difference in histopathology, size, or location of polyps with respect to H. pylori status. Gastric H. pylori infection, age, male gender and high risk clinical presentations were independent risk factors for colorectal polyps. Serological testing also revealed a higher prevalence of H. pylori and its toxin Cag-A in polyp patients vs. non polyp patients' sera, although in a non-statistically significant manner.
This study showed that current gastric H. pylori infection is associated with an increased risk of colorectal polyps in African Americans. Patients with H. pylori induced gastritis may benefit from early screening colonoscopy as a preventative measure for colorectal cancer.
与普通人群相比，非洲裔美国人中胃幽门螺杆菌（H. pylori）感染和结肠息肉更为普遍。我们旨在调查非洲裔美国人中胃H. pylori感染是否与结肠息肉有关。
回顾了40岁及以上（n = 1256）同日接受双向胃肠内镜检查的非洲裔美国人的病历。通过对胃标本进行免疫组织化学评估H. pylori状态。通过对结肠活检组织进行组织学检查确认结肠息肉。通过ELISA分析来自健康和患有息肉患者的血清样本子集（n = 163）中的抗H. pylori和抗CagA抗体。通过逻辑回归模型计算H. pylori对结肠腺瘤和息肉风险的粗略和调整后的影响。
结肠息肉和腺瘤的患病率分别为456（36%）和300（24%）。胃H. pylori感染患者的结肠息肉比未感染患者更普遍[43%对34%；优势比（OR）（95%置信区间）：1.5（1.2 - 1.9），P = 0.001]。患有H. pylori相关慢性活动性胃炎的患者患腺瘤的风险较高[未调整的OR（95%置信区间）：1.3（1.0 - 1.8）；P = 0.04]。就H. pylori状态而言，息肉的组织病理学、大小或位置没有差异。胃H. pylori感染、年龄、男性性别和高风险临床表现是结肠息肉的独立危险因素。血清学检测还显示，息肉患者血清中H. pylori及其毒素Cag - A的患病率高于非息肉患者，尽管差异无统计学意义。
本研究表明，目前胃H. pylori感染与非洲裔美国人结肠息肉风险增加有关。患有H. pylori诱导性胃炎的患者可能受益于早期筛查结肠镜检查，作为预防结直肠癌的措施。
