Colorectal polyp risk in the context of gastric pathology: The roles of intestinal metaplasia and Helicobacter Pylori

Objective: The role of Helicobacter pylori (H. pylori) infection and intestinal metaplasia (IM) in colorectal neoplasia remains unclear. While H. pylori is a recognized cause of upper gastrointestinal disease, its effect on the colorectum is controversial. IM, often arising from chronic gastritis, may reflect systemic mucosal changes with potential relevance to colorectal pathology. Our aim was to investigate the association between H. pylori, IM, and colorectal polyp development.

Materials and methods: In this retrospective cross-sectional study, 626 patients who underwent both upper gastrointestinal endoscopy and colonoscopy were evaluated. Gastric biopsies were examined histologically for H. pylori and IM, and colorectal polyps were assessed for size, location, and histology. Logistic regression was used to identify factors associated with polyp presence.

Results: Colorectal polyps were found in 29.1% of patients, most being tubular adenomas <1 cm. H. pylori infection was not associated with polyps (p=0.979), whereas IM was strongly associated (44.6% vs. 22.8%, p<0.001) and remained significant in multivariate analysis (OR=2.29, 95% CI: 1.60–3.28, p<0.001).

Conclusion: IM is significantly associated with colorectal polyp presence and may serve as a marker to prioritize colonoscopic screening, particularly in intermediate-risk populations. Further prospective studies are warranted to confirm these findings and explore underlying mechanisms.