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ASSOCIATION BETWEEN HELICOBACTER PYLORI INFECTION AND NASAL POLYPS: Α SYSTEMATIC REVIEW AND META-ANALYSIS

Michael Doulberis 1, Ioannis Kountouras 2, Thomas Stadler 3, Christian Meerwein 3, Stergios Polyzos 4, Hasan Kulaksiz 5, Michael Chapman 6, Anastasios Manolakis 7, Gerhard Rogler 8, Daniele Riva 9, Ioannis Linas 10, John Kavaliotis 2, Evangelos Kazakos 2, Maria Mouratidou 2, Christos Liatsos 11, APOSTOLIS PAPAEFTHYMIOY 6

Affiliations

1 Kantonsspital Aarau, Dietikon, Switzerland

2 Aristotle University of Thessaloniki, Hippokratio Hospital, Thessaloniki, Greece

3 University Hospital Zurich, Zurich, Switzerland

4 Aristotle University of Thessaloniki, Thessaloniki, Greece

5 Gastroklinik, Private Gastroenterological Practice, Horgen, Switzerland

6 University College London Hospitals, London, United Kingdom

7 University Of Thessaly Medical School And University Hospital Of Larissa, Larissa, Greece

8 UniversitätsSpital Zürich, Zürich, Switzerland

9 Kantonspital Aarau, Aarau, Switzerland

10 Gastroenterologische Gruppenpraxis / Hirslanden Clinic Beau-Site, Münsingen, Switzerland

11 401 Army General Hospital of Athens, Rafina-Pikermi, Greece

Summary

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A meta-analysis of twelve studies found that Helicobacter pylori infection was significantly more prevalent in patients with nasal polyps compared to controls with normal nasal mucosa.

The pooled rate of H. pylori infection was 32.3% in nasal polyp patients versus 17.8% in controls, with an odds ratio of 4.12, though overall heterogeneity was high at 66%
Subgroup analysis of European studies and studies using immunohistochemistry both showed significantly higher H. pylori prevalence in nasal polyp patients with null heterogeneity
All twelve eligible studies had good quality scores of 6 out of 8 on the Newcastle-Ottawa scale and included patients aged 17-78 years with a male-to-female ratio of 2:1
The authors suggest this first meta-analysis on the topic supports screening for H. pylori in nasal polyp patients with subsequent eradication as a reasonable strategy

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Abstract

Introduction

Helicobacter pylori (Hp), a definite carcinogen, is associated with nasal polyps. This finding encourages screening of patients with nasal polyps, with subsequent eradication of the positive subjects. Hp has been isolated from multiple sites throughout the body including nose and is associated with a plethora of extragastric manifestations. Current evidence reported discrepant data regarding association between Hp infection (Hp-I) and nasal polyps.

Aims & Methods

Aim of this meta-analysis was to assess for first time the strength of this association. We performed an electronic bibliographical search in established medical databases (PubMed, Cochrane, and EMBASE). The enrolled studies were evaluated for risk of bias using the Newcastle-Ottawa scale. The primary outcome was the prevalence of active Hp-I in nasal polyps compared to patients with normal nasal mucosa. Subgroup analysis based on the different study areas and diagnostic methods used to detect Hp-I (PCR, immunohistochemistry, CLO test) was performed to assess for source of heterogeneity. The study outcomes were compared between the two groups through a random-effects model, expressed as odds ratio (OR) and 95% confidence interval. Heterogeneity was calculated through I² tests. Publication bias was verified through visual assessment of funnel plots.

Results

Twelve studies were eligible. Male-to-female ratio was 2:1, and age ranged 17-78 years. All studies had good quality (6/8 Newcastle Ottawa scale). The cumulative pooled rate of Hp-I in the nasal polyp group was 32.3%, and in controls 17.8% (OR:4.12, though with high heterogeneity I²=66%). Subgroup analysis demonstrated that in European studies, the prevalence of Hp-I for nasal polyp group was significantly higher than in controls, yielding null heterogeneity. Subgroup analysis based on the diagnostic technique resulted in null heterogeneity for immunohistochemistry with preserving statistically significant difference in Hp-I prevalence between nasal polyp and control groups.

Conclusion

This first positive systematic review and meta-analysis strengthens further the plethora of extragastric manifestation of Hp. Screening for the bacterium in patients with nasal polyps with subsequent eradication might be a reasonable strategy.

Conference

UEG Week Copenhagen 2023

Topics

Stomach & H. Pylori

Submission format

Abstract

Session

PP 02 H. pylori (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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Measuring what matters: Pros and cons of therapeutic drug monitoring in IBD

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Measuring what matters: Pros and cons of therapeutic drug monitoring in IBD

Krisztina Barbara Gecse 1, Peter Bossuyt 2

Affiliations

1 Department of Gastroenterology and Hepatology, Amsterdam, Netherlands

2 Imelda General Hospital, Bonheiden, Belgium

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Abstract

Event

Postgraduate Teaching Programme Barcelona 2026

Session

Precision in practice: The future of drug optimisation in IBD

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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A MULTICENTER PROSPECTIVE OBSERVATIONAL STUDY OF THE PREDICTION OF ADVANCED HISTOLOGY IN SMALL COLORECTAL POLYPS USING IMAGE-ENHANCED ENDOSCOPY: THE ADVENTURE TRIAL

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A MULTICENTER PROSPECTIVE OBSERVATIONAL STUDY OF THE PREDICTION OF ADVANCED HISTOLOGY IN SMALL COLORECTAL POLYPS USING IMAGE-ENHANCED ENDOSCOPY: THE ADVENTURE TRIAL

Hiroki Yamashita 1, Kinichi Hotta 2, Yoji Takeuchi 3, Tomohiro Iwai 4, Kazuya Ohno 5, Kazuya Hosotani 6, Toshihiro Kusaka 7, Takuji Kawamura 8, Shinya Sugimoto 9, Yasuhiro Tani 3, Yoshihiro Kishida 2, Shigehiko Fujii 7, Takahiro Inoue 3, Hiromu Fukuda 3, Tatsuro Murano 1, Sayo Ito 2, Kenichiro Imai 2, Hiroaki Ikematsu 1

Affiliations

1 National Cancer Center Hospital East, Kashiwa, Japan

2 Shizuoka Cancer Center, Sunto, Japan

3 Osaka International Cancer Institute, Osaka, Japan

4 Toyokawa City Hospital, Toyokawa, Japan

5 Shizuoka General Hospital, Shizuoka, Japan

6 Kobe City Medical Center General Hospital, Kobe, Japan

7 Kyoto Katsura Hospital, Kyoto, Japan

8 Kyoto Second Red Cross Hospital, Kyoto, Japan

9 Ise Red Cross Hospital, Ise, Japan

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Abstract

Introduction

In recent years, cold snare polypectomy (CSP) for small polyps has become popular, but it is considered inappropriate as a treatment for cancer because of the shallow depth of resection at the muscularis mucosa level and the risk of inadequate pathological evaluation. ¹² Therefore, it is important to diagnose advanced histology (AH) (high grade adenoma or adenocarcinoma) prior to treatment. Based on our retrospective review of colorectal neoplastic lesions smaller than 10 mm, the following six endoscopic findings were extracted as significant predictors of AH findings in the multivariate analysis : (1) surface redness, (2) white spots, using white light image, (3) heterogeneity in mucosal pattern, using non-magnified Narrow band imaging (NBI), (4) irregular vessel or surface pattern(equivalent to JNET Type 2B,3), using magnified NBI, (5) loss of lobulation, and (6) non-polypoid growth, using non-magnified chromoendoscopy using indigo carmine. ³

Aims & Methods

The aim of this study was to evaluate the usefulness of image-enhanced endoscopic findings in real-time prediction of AH for small colorectal polyps. Patients scheduled for colonoscopy were recruited for consent prior to the examination at 9 Japanese institutions, and the presence of the aforementioned AH-predictive endoscopic findings was noted for up to 5 lesions per patient when neoplastic polyps of 5-9 mm were detected. If one of the predictive findings was positive, endoscopic resection using the electric current method or surgical resection was applied. The primary endpoint was the negative predictive value (NPV) of the 6 AH-predicting findings using pathology as the gold standard. Secondary endpoints were NPV of AH prediction by modality combination, odds ratios of each predictors and percentage of non-CSP for T1 cancer. Taking account for practical value, the target threshold of NPV was set for 90%.

Results

A total of 1671 patients were enrolled in the study, of which 517 patients with 849 lesions (80 AH lesions) corresponding to 5-9 mm polyps were included in the analysis. The primary endpoint was 0.945 (95% confidence interval (CI): 0.923-0.961). Secondary endpoints were white light + NBI non-magnified/magnified 0.941 (95%CI: 0.920-0.958), white light + NBI non-magnified 0.934 (95%CI: 0.913-0.952), white light + chromoendoscopy 0.926 (95%CI: 0.904-0.944), and white light 0.922 (95%CI: 0.900-0.940). Odds ratio (95%CI) of each 6 findings were as followings; irregular vessel or surface pattern 5.00 (2.59-9.37), loss of lobulation 4.10(1.61-6.56), white spots 3.32(1.60-6.56), non-polypoid growth 3.24(1.13-8.22), heterogeneity 2.53(1.41-4.42), surface redness 1.41(0.56-3.14). All 6 T1 cancer had multiple predictive findings of AH, and the percentage of non-CSP performed was 100%.

Conclusion

Six predictive findings of AH combined with image-enhanced endoscopy were shown to be useful in determining the indication for CSP (UMIN 000040974).

References

1. Ito A, Suga T, Ota H, et al. Resection depth and layer of cold snare polypectomy versus endoscopic mucosal resection. J Gastroenterol 2018;53:1171-1178.
2. Uraoka T, Takizawa K, Tanaka S, et al. Guidelines for Colorectal Cold Polypectomy (supplement to "Guidelines for Colorectal Endoscopic Submucosal Dissection/Endoscopic Mucosal Resection"). Dig Endosc 2022;34:668-675.
3. Iwai T, Imai K, Hotta K, et al. Endoscopic prediction of advanced histology in diminutive and small colorectal polyps. J Gastroenterol Hepatol 2019;34:397-403.

Event

UEG Week Copenhagen 2023

Topics

Colorectal Digestive Oncology Endoscopy Histopathology Radiology & Imaging

Submission format

Abstract

Session

Advanced imaging for advanced colorectal lesion

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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EID for early rectal cancer: The new paradigm?

Leon M.G. Moons 1

Affiliations

1 University Medical Center Utrecht, Utrecht, Netherlands

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Abstract

Event

UEG Week Vienna 2024

Topics

Colorectal Digestive Oncology Endoscopy Surgery

Session

Therapy update: Is en-bloc the new standard for colorectal polyps

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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Innovation technology in surveillance of genetic syndromes?

Maria Pellisé Urquiza 1

Affiliations

1 Hospital Clinic, Barcelona, Spain

Summary

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Abstract

Event

UEG Week Copenhagen 2023

Topics

Colorectal Digestive Oncology Endoscopy Mechanisms & Personalised Medicine Standards & Guidelines Surgery

Session

What's new in oncology in 2023?

Published

2023

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UEG Presentation

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

Summary: Immunotherapy in digestive cancers - Where are we heading?

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Summary: Immunotherapy in digestive cancers - Where are we heading?

Tamara Matysiak-Budnik 1

Affiliations

1 CHU de Nantes IMAD, Nantes, France

Summary

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Abstract

Event

UEG Postgraduate Teaching Programme Berlin 2025

Topics

Digestive Oncology Immunology Mechanisms & Personalised Medicine

Session

Immunotherapy in digestive cancers: Where are we heading?

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

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This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

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The role of endoscopy vs resection for T1a and T1b disease

Jérémie Jacques 1

Affiliations

1 CHU Limoges - Hepato-Gastro-Enterology, CHU Limoges; Limoges/FR, Limoges, France

Summary

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Abstract

Event

UEG Week Vienna 2024

Topics

Colorectal Digestive Oncology Endoscopy Histopathology

Session

Controversies in the management of colorectal neoplasia

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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