Associations between gastric histopathology and the occurrence of colonic polyps

Heterochronic gastric adenosquamous carcinoma combined with colonic adenoma: A case report

BACKGROUND

Metachronous gastric cancer usually refers to a tumor that occurs in the stomach more than half a year after esophageal cancer surgery, and metastasis of primary esophageal cancer should be excluded. There are few reports of metachronous gastric adenosquamous carcinoma with signet ring cell carcinoma combined with early tubular adenoma of the colon after esophageal cancer surgery, which has a high degree of malignancy. This is also the reason for the poor treatment results.

CASE SUMMARY

A 54-year-old male patient was admitted to the hospital with "dysphagia obstruction". Seven years ago, the patient was diagnosed with well-differentiated squamous cell carcinoma in the middle esophagus (T4N1M0 stage) and left gastric lymph node metastasis. In the final resection of the esophageal cancer, no residual cancer tissue was found in the esophageal and gastric stump. The patient's medical history 7 years ago (preoperative gastroscopy and other examinations) revealed no gastric tumor. Combined with the patient's history, the diagnosis of recurrent esophageal cancer was made on this admission. The final pathological results were surprising: Metachronous gastric adenosquamous carcinoma with signet ring cell carcinoma combined with early tubular adenoma of the colon. Considering the high malignancy of the tumor, the complexity of the second operation, and many complications, the patient received chemotherapy.

CONCLUSION

He had a history of esophageal cancer resection. Gastroenteroscopy should be performed simultaneously to avoid missed diagnosis and misdiagnosis.

Esophagogastroscopic Abnormalities Potentially Guided Patients Younger than 50 Years Old to Undergo Colonoscopy Earlier: A Retrospective Cross-Sectional Study

BACKGROUND

The incidence of early-onset colorectal cancer (CRC) is continuously increasing worldwide. Current guidelines in China recommend average-risk individuals starting CRC screening at age 50.

AIMS

To investigate the relationship between the gastric histopathology and colorectal neoplasms to identify CRC risk factors which potentially guide earlier colonoscopy in individuals aged < 50 years.

METHODS

A retrospective cross-sectional study was conducted on 8819 patients younger than age 50 who underwent gastroscopy and colonoscopy simultaneously between November 7, 2020 and November 14, 2022. Multivariate logistic regression was used to evaluate whether various gastric histopathology are risk factors for different types of colorectal polyps, reporting odds ratios (ORs) with corresponding 95% confidence intervals (CIs).

RESULTS

A total of 3390 cases (38.44%) under 50 years old were diagnosed as colorectal polyps. Advanced age (OR 1.66, 95%CI 1.57-1.76), male sex (OR 2.67, 95%CI 2.33-3.08), Helicobacter pylori (H. pylori) infection (OR 1.43, 95%CI 1.24-1.65), gastric polyps (OR 1.29, 95%CI 1.10-1.52), and low-grade intraepithelial neoplasia (LGIN) (OR 2.52, 95%CI 1.39-4.57) were independent risk factors for colorectal adenomas. For non-adenomatous polyps, reflux esophagitis (OR 1.38, 95%CI 1.11-1.71) was also an independent risk factor. Besides, older age (OR 1.90, 95%CI 1.66-2.18), male sex (OR 2.15, 95%CI 1.60-2.87), and H. pylori infection (OR 1.67, 95%CI 1.24-2.24) were associated with a higher risk of advanced neoplasms (advanced adenoma and CRC).

CONCLUSIONS

Earlier colonoscopy for identification and screening may need to be considered for individuals younger than 50 years old with H. pylori infection, LGIN, gastric polyps, and reflux esophagitis. Risk-adapted CRC screening initiation age allows a personalized and precise screening.

Atrophic gastritis rather than Helicobacter pylori infection can be an independent risk factor of colorectal polyps: a retrospective study in China

BACKGROUND

Colonoscopy is considered the most effective screening method for colorectal polyps. However, the longevity and complexity of the procedure makes it less desirable to screen for colorectal polyps in the general population. Therefore, it is essential to identify other independent risk factors. In this study, we explored the link between Hp infection, atrophic gastritis, and colorectal polyps to identify a new potential risk factors of colorectal polyps.

METHODS

In this study, atrophic gastritis and intestinal polyps were diagnosed by endoscopy and pathology. All the 792 patients in this retrospective study were divided into sub-groups based on the presence of colorectal polyps. The correlation between polyps and atrophic gastritis was analyzed using the chi-square test and Kruskal-Wallis test. The receiver operating characteristic (ROC) curve was used to compare the predictive value for colorectal polyps between Hp infection and atrophic gastritis. Binary logistic regression was utilized to identify independent risk factors for colorectal polyps.

RESULTS

Patients with colorectal polyps were primarily male with advanced age, and the number of patients with colorectal polyps had a higher association with smoking, alcohol drinking, and Hp infection than the control group. A positive correlation between the number of colorectal polyps and the severity of atrophic gastritis was observed. ROC analysis showed that atrophic gastritis was a better risk factors for colorectal polyps. Multivariate analysis identified atrophic gastritis as an independent risk factor for colorectal polyps (OR 2.294; 95% CI 1.597-3.296).

CONCLUSIONS

Atrophic gastritis confirmed could be an independent risk factors for colorectal polyps.

Is Helicobacter pylori Anyway Pathogen in Children?

Helicobacter pylori (H. pylori) infection is a continuous challenge for both gastroenterologists and pediatricians. The international guidelines regarding diagnostic and treatment pathways differ between adults and children. The pediatric guidelines are more restrictive because children are rarely affected by serious consequences, particularly in Western countries. Therefore, infected children should be treated only after a careful case-by-case evaluation by a pediatric gastroenterologist. In any case, recent studies are confirming an increasingly all-around pathological role of H. pylori even in asymptomatic children. For these reasons, following the current evidence, we feel that H. pylori-infected children could be treated starting in pre-adolescence, particularly in Eastern countries, because their stomachs have already begun to develop the biomarkers of gastric damage. Therefore, we believe that H. pylori is anyway pathogen in children. Nevertheless, the possible beneficial role of H. pylori in humans has not yet been conclusively disproved.

Trends of Colonic Neoplasia in US Outpatient Endoscopy Centers

BACKGROUND

A variety of studies have shown rising trends in the occurrence of colorectal cancer in younger patients as opposed to falling trends among older patients aged 55 years or more. We hypothesized that the time trends of benign colonic precursor lesions would reveal similar patterns.

AIMS

The present study was designed to test this hypothesis in a large nationwide sample of the US population undergoing colonoscopy in community-based endoscopy centers.

METHODS

The Inform Diagnostics database is an electronic repository of histopathologic records of patients distributed throughout the USA. A cross-sectional study analyzed the detection rates of sessile serrated adenomas (SSA), hyperplastic polyps (HP), tubular adenomas (TA), traditional serrated adenomas (TSA), or adenocarcinomas (colorectal cancer, CRC) in 2,910,174 colonoscopies done 2008-2020.

RESULTS

During the 13-year time period, the rate of SSA showed a significant rise, both in patients younger and older than 55 years. HP and TA both showed a significant decline during the same time period. The trends of CRC in the older age group decreased significantly between 2008 (or its peak in 2012) and 2020. The trends of CRC in the younger age group increased significantly between 2008 and its peak in 2017.

CONCLUSIONS

The age-specific time trends of benign and malignant colonic neoplasia are characterized by dissimilar temporal patterns. Such dissimilarity could suggest that besides a set of shared risk factors that affect all types of colonic neoplasia alike, there is yet another set of environmental risk factors that specifically influence malignant transformation.

Synchronous occurrence of different polyp types during colonoscopy

BACKGROUND AND AIMS

The general probabilities of finding different types of hyperplastic or neoplastic colon lesions clustering in the same patient are unknown. We hypothesised that a systematic analysis of polyp clustering would reveal a high frequency of different concurrent types and that such clustering would be influenced by the underlying histopathology of the individual polyps.

METHODS

Using an electronic database of histopathologic records, a cross-sectional study of 2,910,174 colonoscopies evaluated the concordant occurrence of hyperplastic and neoplastic mucosal lesions.

RESULTS

Amongst patients harbouring any colon polyp, one can expect to find another histopathologic type in about 22%. Being the most prevalent type of polyp, tubular adenoma was the most common type of colonic polyp to be associated with other lesions. For instance, 31% of all colonoscopies with sessile serrated adenomas or hyperplastic polyps also revealed tubular adenomas. Hyperplastic polyp, the second most prevalent type of colonic polyp, was also the second most common type of polyp to be found associated with other types of neoplasia. For instance, 25% of all colonoscopies with sessile serrated adenomas and 31% of those with tubular adenomas also revealed hyperplastic polyps.

CONCLUSIONS

Different types of colon polyps commonly coincide in individual patients. The present set of data from a large nationwide database may provide guidance for the endoscopist of what variety in colon polyps to expect during colonoscopy.

The Potential Value of Gastric Histopathology for Predicting Colorectal Adenomatous Polyps Among the Chinese Population: A Retrospective Cross-Sectional Study

Background

It remains unknown whether gastric histopathology is associated with the occurrence of colonic neoplasms. We aimed to clarify the association between gastric histopathology and different types of colorectal polyps (CP) and colorectal cancer (CRC), and whether various gastric histopathologies are risk factors for different types of CP and CRC.

Methods

A retrospective cross-sectional study was conducted on 5,986 patients who underwent gastroscopy and colonoscopy simultaneously at Shaoxing People’s Hospital from August 1, 2019, to May 31, 2020. The Pearson χ² test was used to analyze the occurrence of various gastric histopathologies in different types of CP and CRC, and logistic regression was used to determine whether various gastric histopathologies were risk factors for different types of CP and CRC.

Results

For the Chinese population, male sex (odds ratio [OR] 1.67, 95% confidence interval [CI] 1.41–1.97, P < 0.001) and old age (OR 1.03, 95% CI 1.02–1.04, P < 0.001) were risk factors for non-adenomatous polyps (NAP), but Helicobacter pylori (H. pylori) and various gastric histopathologies were not significant in the NAP compared with the normal group. Nevertheless, it is noteworthy that, similar to male sex and old age, H. pylori (OR 1.22, 95% CI 1.08–1.38, P = 0.002), low-grade intraepithelial neoplasia (LGIN) (OR 1.79, 95% CI 1.21–2.66, P = 0.004), gastric fundus gland polyps (FGPs) (OR 1.44, 95% CI 1.11–1.87, P = 0.007), hyperplastic/inflammatory gastric polyps (GHP or GIP) (OR 1.50, 95% CI 1.06–2.12, P = 0.022), and atrophy/intestinal metaplasia (AG or IM) (OR 1.27, 95% CI 1.13–1.43, P < 0.001) were all risk factors for colorectal adenomatous polyps (AP). However, the results of CRC showed that old age (OR 1.13, 95% CI 1.10–1.16, P < 0.001) and H. pylori (OR 1.67, 95% CI 0.99–2.75, P < 0.05) were risk factors for CRC (OR 1.67, 95% CI 0.99–2.75, P < 0.05), but not sex and various gastric histopathologies (P > 0.05).

Conclusion

Gastric histopathology, such as AG or IM, LGIN, FGP, and GHP or GIP, were risk factors for AP, but not for NAP and CRC, indicating that gastric histopathology has potential predictive value for AP in the Chinese population.

Association Between H. pylori Infection and Colorectal Polyps: A Meta-Analysis of Observational Studies

Background

It has been suggested that Helicobacter pylori (H. pylori) infection is associated with hypergastrinemia and proliferation of colorectal mucosa via direct stimulation, dysbiosis of the gut microbiome, and changes in the gut microbiome, all of which may lead to the formation of colorectal polyps. However, the consensus remains lacking regarding whether H. pylori infection is independently associated with colorectal polyps and whether the association differs according to histological type of colorectal polyps. To summarize the current evidence regarding the relationship between H. pylori infection and colorectal polyps, we conducted a meta-analysis of related observational studies according to the histological types of colorectal polyps.

Methods

Observational studies investigating the association between H. pylori infection and colorectal polyps using multivariate analyses were included by search of PubMed, Embase, and Web of Science. A random-effects model was adopted to combine the results.

Results

Seventeen studies that include 322,395 participants were analyzed. It was shown that H. pylori infection was independently associated with overall colorectal polyps (odds ratio [OR]: 1.67, 95% CI: 1.24–2.24, p < 0.001; I² = 73%). According to the histological type of colorectal polyps, H. pylori infection was independently associated with adenomatous polyps (APs; OR: 1.71, 95% CI: 1.47–1.99, p < 0.001; I² = 86%), advanced APs (OR: 2.06, 95% CI: 1.56–2.73, p < 0.001; I² = 0%), and hyperplastic polyps (HPs; OR: 1.54, 95% CI: 1.02–2.30, p = 0.04; I² = 78%). Evidence based on only one study showed that H. pylori infection was not associated with sessile serrated polyps (SSPs; OR: 1.00, 95% CI: 0.93–1.07, p = 0.99).

Conclusions

Current evidence from case-control and cross-sectional studies suggested that H. pylori infection was independently associated with colorectal APs, advanced APs, and HPs, but not with SSPs. These findings suggested H. pylori infection may be a possible risk factor of colorectal polyp, which is important for the prevention of colorectal polyp in the adult population.

Epidemiology of Helicobacter pylori

In many countries alike, the time trends of gastric cancer, gastric and duodenal ulcer, ulcerative colitis, Crohn's disease, and colorectal cancer are characterized by similar birth-cohort patterns. Mortality from these diagnoses rose in cohorts born during the 19th century and then fell in subsequent cohorts born during the 20th century.

Clinical features of fundic gland polyps and their correlation with colorectal tumors

Fundic gland polyps (FGPs) are multiple, sessile polypoid bumps formed by the gastric mucosa of the fundus and body, which are the most common type of gastric polyps and generally tend to be benign. Studies have shown that patients with FGPs have a higher risk of developing colorectal tumors (adenoma and cancer) than the general population, but their correlation is still controversial. This article is aimed to review the clinical features of FGPs and their correlation with colorectal tumors.