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Kim, Baik, Kim, Oh, and Lee: Prevalence and Risk Factors of Colorectal Adenoma in 14,932 Koreans Undergoing Screening Colonoscopy
Original Article

Korean J Gastroenterol 2013;62(2):104-110.

Published online: 4 October 2013

DOI: https://doi.org/10.4166/kjg.2013.62.2.104

Prevalence and Risk Factors of Colorectal Adenoma in 14,932 Koreans Undergoing Screening Colonoscopy

Hee Sun Kim, Su Jung Baik, Kyung Hee Kim, Cho Rong Oh, Sang In Lee

Health Promotion Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea

Correspondence to: Hee Sun Kim, Health Promotion Center, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 135-720, Korea. Tel: +82-2-2019-1290, Fax: +82-2-3462-8209, E-mail: aderheesun@yuhs.ac

Received 26 March 2013       Revised 8 July 2013       Accepted 9 July 2013

Copyright © 2013 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

Current international guidelines recommend colorectal cancer screening for average-risk people over 50 years of age. Accordingly, we aimed to estimate the prevalence of colorectal neoplasms in all age groups and evaluate associated risk factors.

Methods

Data of 14,932 subjects who underwent colonoscopy from July 2006 to January 2012 at Health Promotion Center, Gangnam Severance Hospital (Seoul, Korea) as part of a health check-up were reviewed retrospectively.

Results

The overall prevalence of colorectal neoplasms and adenoma were 34.6% and 25.3%, respectively. Colorectal adenoma was found in 3.2%, 13.0%, 21.7%, 33.8%, 44.0%, 50.5%, and 54.2% of subjects under 30 years, 30–39 years, 40–49 years, 50–59 years, 60–69 years, 70–79 years, and over 80 years of age (trend p＜0.0001). Independent predictors of colorectal adenoma included male gender (OR 2.38, 95% CI 2.084–2.718), positive occult blood (2.266, 1.761–2.917), positive serology of Helicobacter pylori (1.253, 1.114–1.409) and hypertriglyceremia (1.267, 1.065–1.508). Compared to the 30–39 years of age reference group, the ORs for each age group were 0.195 (under 30 years), 1.634 (40–49 years), 2.954 (50–59 years), 5.159 (60–69 years), 5.640 (70–79 years), 11.020 (over 80 years), while the 95% CIs were 0.071–0.536 (under 30 years), 1.340–1.992 (40–49 years), 2.421–3.604 (50–59 years), 4.109–6.476 (60–69 years), 3.822–8.322 (70–79 years), and 2.809–42.234 (over 80 years).

Conclusions

Colorectal adenoma prevalence increased proportionally with age. Only subjects under the age of 30 years had a definitely lower prevalence of colorectal adenoma. Male gender, positive occult blood, positive serology of H. pylori, and hypertriglyceremia were associated risk factors of colorectal adenoma.

Keywords: Colorectal adenoma, Helicobacter pylori, Occult blood, Triglycerides, Colonoscopy

References

1. Jung KW, Park S, Kong HJ, et al. Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2008. Cancer Res Treat. 2011; 43:1–11.
crossref
2. Hill MJ, Morson BC, Bussey HJ. Aetiology of adenoma–carcinoma sequence in large bowel. Lancet. 1978; 1:245–247.
3. Vogelstein B, Fearon ER, Hamilton SR, et al. Genetic alterations during colorectal-tumor development. N Engl J Med. 1988; 319:525–532.
crossref
4. Chung SJ, Kim YS, Yang SY, et al. Prevalence and risk of colorectal adenoma in asymptomatic Koreans aged 40–49 years undergoing screening colonoscopy. J Gastroenterol Hepatol. 2010; 25:519–525.
5. Chung YW, Han DS, Park YK, et al. Association of obesity, serum glucose and lipids with the risk of advanced colorectal adenoma and cancer: a casecontrol study in Korea. Dig Liver Dis. 2006; 38:668–672.
crossref
6. Boursi B, Halak A, Umansky M, Galzan L, Guzner-Gur H, Arber N. Colonoscopic screening of an average-risk population for colorectal neoplasia. Endoscopy. 2009; 41:516–521.
crossref
7. Kim Y, Jun JK, Choi KS, Lee HY, Park EC. Overview of the national cancer screening programme and the cancer screening status in Korea. Asian Pac J Cancer Prev. 2011; 12:725–730.
8. Lee BI, Hong SP, Kim SE, et al. MultiSociety Task Force for Development of Guidelines for Colorectal Polyp Screening, Surveillance and Management. Korean guidelines for colorectal cancer screening and polyp detection. Korean J Gastroenterol. 2012; 59:65–84.
crossref
9. Chobanian AV, Bakris GL, Black HR, et al. The seventh report of the joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003; 289:2560–2572.
crossref
10. Levin B, Lieberman DA, McFarland B, et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US MultiSociety Task Force on Colorectal Cancer, and the American College of Radiology. Gastroenterology. 2008; 134:1570–1595.
crossref
11. Rondagh EJ, Bouwens MW, Riedl RG, et al. Endoscopic appearance of proximal colorectal neoplasms and potential implications for colonoscopy in cancer prevention. Gastrointest Endosc. 2012; 75:1218–1225.
crossref
12. Betés M, Muñoz-Navas MA, Duque JM, et al. Use of colonoscopy as a primary screening test for colorectal cancer in average risk people. Am J Gastroenterol. 2003; 98:2648–2654.
crossref
13. Byeon JS, Yang SK, Kim TI, et al. Asia Pacific Working Group for Colorectal Cancer. Colorectal neoplasm in asymptomatic Asians: a prospective multinational multicenter colonoscopy survey. Gastrointest Endosc. 2007; 65:1015–1022.
crossref
14. Liu HH, Wu MC, Peng Y, Wu MS. Prevalence of advanced colonic polyps in asymptomatic Chinese. World J Gastroenterol. 2005; 11:4731–4734.
crossref
15. Soon MS, Kozarek RA, Ayub K, Soon A, Lin TY, Lin OS. Screening colonoscopy in Chinese and Western patients: a comparative study. Am J Gastroenterol. 2005; 100:2749–2755.
crossref
16. Leung WK, Ho KY, Kim WH, et al. Asia Pacific Working Group on Colorectal Cancer. Colorectal neoplasia in Asia: a multicenter colonoscopy survey in symptomatic patients. Gastrointest Endosc. 2006; 64:751–759.
crossref
17. Youn SJ, Kim NY, Kim YT, et al. Colorectal polyp in Korea. Korean J Gastroenterol. 1991; 23:450–458.
18. Park DI, Kim YH, Kim HS, et al. Diagnostic yield of advanced colorectal neoplasia at colonoscopy, according to indications: an investigation from the Korean Association for the Study of Intestinal Diseases (KASID). Endoscopy. 2006; 38:449–455.
crossref
19. Park HW, Byeon JS, Yang SK, et al. Colorectal neoplasm in asymptomatic average-risk Koreans: The KASID prospective multicenter colonoscopy survey. Gut Liver. 2009; 3:35–40.
crossref
20. Hong SN, Yang DH, Kim YH, et al. MultiSociety Task Force for-Development of Guidelines for Colorectal Polyp Screening, Surveillance and Management. Korean guidelines for post-polypectomy colonoscopic surveillance. Korean J Gastroenterol. 2012; 59:99–117.
crossref
21. Kim JH, Lim YJ, Kim YH, et al. Is metabolic syndrome a risk factor for colorectal adenoma? Cancer Epidemiol Biomarkers Prev. 2007; 16:1543–1546.
crossref
22. Kim YJ, Lee KM, Chung WC, Paik CN, Jung SH. Association between measures of obesity and colorectal adenoma. Chin Med J (Engl). 2011; 124:3711–3715.
23. Sun ZJ, Huang YH, Wu JS, et al. The association of serum lipids with the histological pattern of rectosigmoid adenoma in Taiwanese adults. BMC Gastroenterol. 2011; 11:54.
crossref
24. Tabuchi M, Kitayama J, Nagawa H. Hypertriglyceridemia is positively correlated with the development of colorectal tubular adenoma in Japanese men. World J Gastroenterol. 2006; 12:1261–1264.
crossref
25. Lee HL, Son BK, Lee OY, et al. Abdominal obesity, insulin resistance, and the risk of colonic adenoma. Korean J Gastroenterol. 2007; 49:147–151.
26. Aaronson SA. Growth factors and cancer. Science. 1991; 254:1146–1153.
crossref
27. Giovannucci E. Insulin, insulin-like growth factors and colon cancer: a review of the evidence. J Nutr. 2001; 131(11 Suppl):3109S–3120S.
crossref
28. Abbass K, Gul W, Beck G, Markert R, Akram S. Association of Helicobacter pylori infection with the development of colorectal polyps and colorectal carcinoma. South Med J. 2011; 104:473–476.
29. Aydin A, Karasu Z, Zeytinoglu A, Kumanlioglu K, Ozacar T. Colorectal adenomateous polyps and Helicobacter pylori infection. Am J Gastroenterol. 1999; 94:1121–1122.
30. Breuer-Katschinski B, Nemes K, Marr A, et al. Helicobacter pylori and the risk of colonic adenomas. Colorectal Adenoma Study Group. Digestion. 1999; 60:210–215.
31. Moss SF, Neugut AI, Garbowski GC, Wang S, Treat MR, Forde KA. Helicobacter pylori seroprevalence and colorectal neoplasia: evidence against an association. J Natl Cancer Inst. 1995; 87:762–763.
32. Hong SN, Lee SM, Kim JH, et al. Helicobacter pylori infection increases the risk of colorectal adenomas: cross-sectional study and metaanalysis. Dig Dis Sci. 2012; 57:2184–2194.
33. Zhao YS, Wang F, Chang D, Han B, You DY. Meta-analysis of different test indicators: Helicobacter pylori infection and the risk of colorectal cancer. Int J Colorectal Dis. 2008; 23:875–882.
34. Sonnenberg A, Genta RM. Helicobacter pylori is a risk factor for colonic neoplasms. Am J Gastroenterol. 2013; 108:208–215.
35. Thorburn CM, Friedman GD, Dickinson CJ, Vogelman JH, Oren-treich N, Parsonnet J. Gastrin and colorectal cancer: a prospective study. Gastroenterology. 1998; 115:275–280.
crossref
36. Jones M, Helliwell P, Pritchard C, Tharakan J, Mathew J. Helicobacter pylori in colorectal neoplasms: is there an aetiological relationship? World J Surg Oncol. 2007; 5:51.
crossref
37. Shmuely H, Passaro D, Figer A, et al. Relationship between Helicobacter pylori CagA status and colorectal cancer. Am J Gastroenterol. 2001; 96:3406–3410.
38. Lee SH, Lee KS, Lee JY, et al. Clinical usefulness of fecal occult blood test as a screening method for asymptomatic patients with colon polyps. Korean J Gastroenterol. 2006; 48:388–394.
39. Nakama H, Abdul Fattah AS, Zhang B, Kamijo N, Fujimori K, Miyata K. Detection rate of immunochemical fecal occult blood test for colorectal adenomatous polyps with severe dysplasia. J Gastroenterol. 1997; 32:492–495.
crossref

Fig. 1.
Prevalence of colorectal polyp according to histology.
kjg-62-104f1.tif
Fig. 2.
Prevalence of colorectal adenoma according to age groups.
kjg-62-104f2.tif
Fig. 3.
Number of colorectal adenoma according to age groups.
kjg-62-104f3.tif
Table 1.
Clinical Characteristics of Subjects with Colorectal Adenoma
Characteristic Colorectal adenoma (%, n=3,780) Normal (%, n=9,762) p-value
Male 72.3 52.3 ＜0.0001
Age (yr)     ＜0.0001
 ＜30 0.3 3.1  
 30–39 6.8 17.5  
 40–49 26.1 36.5  
 50–59 39.7 30.1  
 60–69 21.6 10.7  
 70–79 5.2 2.0  
 ≥80 0.3 0.1  
Blood pressure (mmHg)     ＜0.0001
 Normal 32.5 43.4  
 Pre-HTN 45.2 41.0  
 HTN 22.3 15.6  
BMI (kg/m2)     ＜0.0001
 ＜18.5 2.2 5.3  
 ＜23.0 33.2 43.9  
 ＜25.0 28.9 24.2  
 ≥25.0 35.7 26.6  
Anti H. pylori IgG(＋) 59.5 51.6 ＜0.0001
FOBT(＋) 6.9 3.4 ＜0.0001
TC (≥240 mg/dL) 13.1 11.4 0.005
LDL-c (≥160 mg/dL) 14.1 11.7 0.0001
HDL-c (＜40 mg/dL) 21.6 14.8 ＜0.0001
TG (≥200 mg/dL) 15.9 10.6 ＜0.0001

HTN, hypertension; H. pylori, Helicobacter pylori; FOBT, fecal occult blood test; TC, total cholesterol; LDL-c, LDL cholesterol; HDL-c, HDL cholesterol; TG, triglyceride.

Table 2.
Multiple Logistic Regression Analysis of the Risk Factors Associated with Colorectal Adenoma
Variable OR 95% CI p-value
Female 1      
Male 2.380 2.084 2.718 ＜0.0001
 Age (yrs)        
 ＜30 0.195 0.071 0.536 0.0015
 30–39 1      
 40–49 1.634 1.340 1.992 ＜0.0001
 50–59 2.954 2.421 3.604 ＜0.0001
 60–69 5.159 4.109 6.476 ＜0.0001
 70–79 5.640 3.822 8.322 ＜0.0001
 ≥80 11.020 2.809 43.234 0.0006
Blood pressure (mmHg)        
 Normal 1.000      
 Pre-HTN 0.955 0.836 1.091 0.4994
 HTN 0.931 0.782 1.108 0.4225
BMI (kg/m2)        
 ＜18.5 0.927 0.644 1.334 0.6828
 ＜23.0 1      
 ＜25.0 1.178 1.017 1.366 0.0292
 ≥25.0 1.147 0.986 1.334 0.0757
Anti H. pylori IgG(＋) 1.253 1.114 1.409 0.0002
FOBT(＋) 2.266 1.761 2.917 ＜0.0001
TC (≥240 mg/dL) 0.994 0.781 1.265 0.9629
LDL-c (≥160 mg/dL) 1.184 0.939 1.495 0.1539
HDL-c (＜40 mg/dL) 1.140 0.971 1.338 0.1105
TG (≥200 mg/dL) 1.267 1.065 1.508 0.0076

HTN, hypertension; H. pylori, Helicobacter pylori; FOBT, fecal occult blood test; TC, total cholesterol; LDL-c, LDL cholesterol; HDL-c, HDL cholesterol; TG, triglyceride.

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