MD Creighton University School of Medicine Phoenix, Arizona
Mays Almohammedawi, MBChB1, Ali Alshati, MD2, Arnold Forlemu, MD2, Dimas Kosa, MD2, Simcha Weissman, DO3, Mohammed Alkhero, MD4, Toufic Kachaamy, MD5; 1Baghdad University College of Medicine, Phoenix, AZ; 2Creighton University School of Medicine, Phoenix, AZ; 3Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ; 4Universal Health Services Southern California Medical Education Consortium, Phoenix, AZ; 5Cancer Treatment Centers of America, Phoenix, AZ
Introduction: Colorectal cancer (CRC) has an incidence rate of > 100,000 cases annually. It has multiple factors implicated in its pathogenesis. Helicobacter Pylori (H. pylori), which is classified as a class I carcinogen, has been postulated as a possible risk factor for CRC, however, evidence has not been conclusive. The purpose of this study is to investigate the association between H. Pylori infection and CRC using a large database. Methods: We used the 2009 to 2014 nationwide inpatient sample database (NIS) for this study. NIS is the largest publicly available all‐payer inpatient database in the United States that >7 million hospital stays each year, as a part of the Healthcare Cost and Utilization Project (HCUP). International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9CM) codes for H pylori and CRC (including cecal, ascending colon, hepatic flexure, transverse colon, splenic flexure, descending colon, sigmoid and rectum) were obtained. Logistic regression was used to model the association between H. pylori and CRC. Included participants were aged 18 and above. Results: From 2009 to 2014 there were 291,785 patients identified with CRC. The mean age of diagnosis was 64 years. The female to male ratio was 1.46:1 and the majority of the included patients were white at 68.5%. There was a significant association between H. pylori infection and the diagnosis of CRC (P< 0.001), regardless of the anatomic site. Using logistic regression, H. pylori was independently positively associated with CRC in addition to other factors listed in table 1. Discussion: H. Pylori association with CRC remains controversial and unclear. Multiple studies, using various methods to describe this association including polymerase chain reaction, urea breath test, H. pylori serology, and gastrin level, have found conflicting results. In a systematic review that included 16 studies, 6 studies demonstrated a statistically significant association between H. Pylori and CRC, while the other 10 studies showed no association. However, these studies were limited by their relatively small sample sizes. In our study, we used a large database of patients, and our findings demonstrate a strong positive association between H. pylori infection and CRC. Further research is needed to evaluate the definitive cause and effect relationship between these two conditions, as well as study the strains of H. pylori that are more likely to cause malignancy and/or subsets of CRC that are vulnerable to H. Pylori infection.
Table 1: Factors associated with colorectal cancer
Disclosures: Mays Almohammedawi indicated no relevant financial relationships. Ali Alshati indicated no relevant financial relationships. Arnold Forlemu indicated no relevant financial relationships. Dimas Kosa indicated no relevant financial relationships. Simcha Weissman indicated no relevant financial relationships. Mohammed Alkhero indicated no relevant financial relationships. Toufic Kachaamy indicated no relevant financial relationships.