Helicobacter pylori infection and colorectal cancer risk: evidence from a large population-based case-control study in Germany

Am J Epidemiol. 2012 Mar 1;175(5):441-50. doi: 10.1093/aje/kwr331. Epub 2012 Jan 31.


Evidence concerning the role of Helicobacter pylori infection in the development of colorectal cancer remains controversial. The authors assessed the association of H. pylori seroprevalence with risk of colorectal cancer in a large population-based case-control study from Germany in 2003-2007. Serum antibodies to H. pylori in general and the cytotoxin-associated gene A protein (CagA) were measured in 1,712 incident colorectal cancer cases and 1,669 controls. The association between H. pylori seroprevalence and colorectal cancer risk was estimated by logistic regression, with adjustment for potential confounders and stratification by age group, sex, anatomic subsites, and cancer stage. Overall, H. pylori seroprevalence was higher in cases (46.1%) than in controls (40.1%), resulting in an age- and sex-adjusted odds ratio of 1.30 (95% confidence interval (CI): 1.14, 1.50). Adjustment for established colorectal cancer risk factors decreased the odds ratio to 1.26 (95% CI: 1.09, 1.47), with a further reduction to 1.18 (95% CI: 1.01, 1.38) after additional adjustment for previous colorectal endoscopy. Stratified analyses showed risk elevation to be essentially confined to left-sided colorectal cancer, with an odds ratio of 1.22 (95% CI: 1.02, 1.45), suggesting that H. pylori infection may be associated with a small yet relevant risk increase in the left colorectum.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antibodies, Bacterial / blood
  • Antigens, Bacterial / blood
  • Bacterial Proteins / blood
  • Case-Control Studies
  • Colorectal Neoplasms / microbiology*
  • Enzyme-Linked Immunosorbent Assay
  • Female
  • Helicobacter Infections / blood
  • Helicobacter Infections / complications*
  • Helicobacter pylori* / immunology
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Odds Ratio
  • Seroepidemiologic Studies


  • Antibodies, Bacterial
  • Antigens, Bacterial
  • Bacterial Proteins
  • cagA protein, Helicobacter pylori