Konstantin Peysin, DO1, Samiran Roy Chaudhury, MD1, Mohammad K. Choudhry, MD2, Meron Debesai, MD1, Masoud Haghi, MD1, Baron Ekeledo, MD1, Jamila Holloway, MD1, Michael Bernstein, MD1
1Coney Island Hospital, Brooklyn, NY; 2NYCHHC-Coney Island Hospital, Brooklyn, NY
Introduction: HP has long been recognized as a carcinogen due to its association with gastric neoplasia. Recently, the link between HP and colonic dysplasia has been studied with results suggesting an association between the two entities. Despite the steady fall of colon cancer rates with the routine utilization of colonoscopy, rates of advanced disease diagnosed before age 50 are increasing. This leaves room for additional tools to help identify patients at risk for colonic dysplasia. We aim to further investigate the association of colonic dysplasia and HP.
Methods: IRB approved, single center, retrospective chart review of patients who underwent a colonoscopy, within one year of an esophagogastroduodenoscopy (EGD) with gastric biopsy, between January 2010 and December 2018 at Coney Island Hospital. Exclusions included age < 18, incomplete colonoscopy, inflammatory bowel disease, polyposis syndromes, personal history of colon cancer, prior polypectomy or HP eradication prior to the study window. For each patient, we noted age, sex, BMI, HP status, total number of polyps, adenomas, advanced adenomas, serrated polyps, colorectal cancer, smoking, diabetes, and alcohol history. Advanced adenomas were defined as >1cm and/or containing a villous component and/or containing high grade dysplasia.
Results: A total of 3175 patients had a colonoscopy within one year of an EGD during the study window. Of these, 1786 were included after chart review. 471(26%) patients were < 50 years old. There were 654 (37%) HP positive patients. Groups were well matched for BMI, diabetes, alcohol abuse and smoking history (Figure 1). Patients with HP infection were found to have a statistically significant difference in rates of advanced adenomas (6.4% in HP-positive patients vs. 3.5% in HP-negative patients, p=0.004). There were no statistically significant differences between the two groups for all polyps (33% vs 31%, p=0.22), all adenomas (25% vs 23%, P=0.21) and adenocarcinoma (1.2% vs 1.3%, p=0.52). Patients< 50 years old showed a trend towards more advanced adenomas (2.7% vs 1.4%, p=0.102).
Discussion: Patients with HP infection were twice as likely to have an advanced adenoma on index colonoscopy. This trend continued in patients < 50 years old without reaching statistical significance. Advanced adenomas are a significant risk factor for adenocarcinoma. This data makes a case for including HP status as a risk factor for colorectal carcinoma and may suggest the need for earlier screening in affected patients.
Citation: Konstantin Peysin, DO; Samiran Roy Chaudhury, MD; Mohammad K. Choudhry, MD; Meron Debesai, MD; Masoud Haghi, MD; Baron Ekeledo, MD; Jamila Holloway, MD; Michael Bernstein, MD. P1030 - ASSOCIATION OF HELICOBACTER PYLORI (HP) INFECTION WITH ADVANCED ADENOMAS OF THE COLON. Program No. P1030. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.