Helicobacter pylori infection, anti-Helicobacter pylori treatment and risk of colorectal cancer and adenoma: an observational study and a meta-analysis
Bibliographic record
Abstract
Background Recent studies suggest a possible link between Helicobacter pylori (H. pylori) infection and risk of colorectal cancer. We examined the association between H. pylori infection, anti- H. pylori treatment, and colorectal cancer and its precursor, adenoma, based on an observational study and a meta-analysis. Methods The observational study part included 3475 participants undergoing colonoscopy and H. pylori testing within the framework of a screening program in Zhejiang Province, China between March 8 and December 29, 2023. Logistic regression models were used to analyze the associations between H. pylori infection and the risk of colorectal cancer and adenoma. Additionally, a meta-analysis was conducted on the associations of H. pylori infection, anti- H. pylori treatment and risk of colorectal cancer and adenoma. Three databases (PubMed, Embase, and Cochrane Library) were searched for relevant studies from inception up to April 9, 2025. Two reviewers independently screened records for eligibility, extracted summary-level data and assessed study quality. Random-effects models were used to calculate the pooled odds ratios (ORs) and 95% confidence intervals (CIs). Study quality was evaluated using the Newcastle–Ottawa Scale for case–control and cohort studies, and adhering to the Agency for Healthcare Research and Quality's recommendations for cross-sectional studies. Heterogeneity was quantified using I 2 statistics and subgroup analyses were conducted to identify potential sources. We used funnel plots to assess publication bias, and Duval and Tweedie's "trim-and-fill" analysis to correct potential bias. Certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation system. The protocol for meta-analysis was registered in PROSPERO (CRD42024566640). Findings The observational study found a statistically significant association between H. pylori infection and the odds of colorectal cancer (n = 31, OR=2.57, 95% CI: 1.26–5.39) and adenoma (n = 1245, OR=1.37, 95% CI: 1.19–1.59), especially for advanced adenoma (n = 486, OR=1.94, 95% CI: 1.59–2.38), compared with normal or non-adenomatous lesions (n = 2199). Meta-analysis of this and 54 other studies, with a total of 48,945,236 participants, found that H. pylori infection was positively associated with colorectal cancer (OR = 1.59, 95% CI: 1.39–1.82, I 2 = 89%) and adenoma (OR = 1.47, 95% CI: 1.36–1.59, I 2 = 88%), especially with advanced adenoma (OR = 1.77, 95% CI: 1.56–2.00, I 2 = 65%). The OR of overall colorectal neoplasia (colorectal cancer or adenoma) was 1.49 (95% CI: 1.39–1.60, I 2 = 91%). Based on meta-analysis of 3 retrospective studies, anti- H. pylori treatment was associated with a reduced overall risk of colorectal neoplasia (OR = 0.44, 95% CI: 0.20–0.97, I 2 = 93%). Interpretation H. pylori infection may represent a significant risk factor for the development of colorectal cancer. The effect of anti- H. pylori treatment on colorectal cancer incidence and mortality necessitates further investigation through large-scale, randomized controlled trials with prolonged follow-up durations. Funding This work was supported by National Natural Science Foundation of China (No. 82404341, No. 82273704), Noncommunicable Chronic Diseases-National Science and Technology Major Project (No. 2023ZD0501400-2023ZD0501402), Beijing Hospitals Authority's Ascent Plan (DFL20241102), Peking University Medicine Fund for World's Leading Discipline or Discipline Cluster Development (No. BMU2022XKQ004), Science Foundation of Peking University Cancer Hospital (No. BJCH2024BJ02), Healthy Zhejiang One Million People Cohort (K-20230085), German Research Foundation (DFG, GE 2042/24-1).
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.003 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".