The Effect of Helicobacter pylori Infection on Recurrence of Gastric Hyperplastic Polyp after Endoscopic Removal

Kyu Ho Kang; Su Hyun Hwang; Dongwoo Kim; Dae-Ha Kim; Seung Young Kim; Jong Jin Hyun; Sung Woo Jung; Ja Seol Koo; Young Kul Jung; Hyung Joon Yim; Sang Woo Lee

doi:10.4166/kjg.2018.71.4.213

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Kang, Hwang, Kim, Kim, Kim, Hyun, Jung, Koo, Jung, Yim, and Lee: The Effect of Helicobacter pylori Infection on Recurrence of Gastric Hyperplastic Polyp after Endoscopic Removal

Original Article

Korean J Gastroenterol 2018;71(4):213-218.

Published online: 4 October 2018

DOI: https://doi.org/10.4166/kjg.2018.71.4.213

The Effect of Helicobacter pylori Infection on Recurrence of Gastric Hyperplastic Polyp after Endoscopic Removal

Kyu Ho Kang, Su Hyun Hwang, Dongwoo Kim, Dae-Ha Kim, Seung Young Kim, Jong Jin Hyun, Sung Woo Jung, Ja Seol Koo, Young Kul Jung, Hyung Joon Yim, Sang Woo Lee

Division of Gastroenterology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea

Correspondence to: Sang Woo Lee, Division of Gastroenterology, Department of Internal Medicine, Korea University Ansan Hospital, 123 Jeokgeum-ro, Danwon-gu, Ansan 15355, Korea. Tel: +82-31-412-5580, Fax: +82-31-8099-6373, E-mail: leesw@kumc.or.kr

Received 19 December 2017 Revised 11 January 2018 Accepted 26 January 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

Several previous studies suggest that eradication of Helicobacter pylori (H. pylori) leads to the disappearance of gastric hyperplastic polyps. However, little is known about the effect of H. pylori status and eradication on the recurrence of gastric polyps after endoscopic removal. Here, we investigated the recurrence of gastric polyps according to the final H. pylori status in patients who underwent endoscopic removal of gastric hyperplastic polyps.

Methods

Between January 2011 and December 2016, patients who underwent endoscopic removal of gastric hyperplastic polyps and were followed-up for more than two months were enrolled. The success of H. pylori eradication was assessed by histology and rapid urease test or urea breath test, at least 4 weeks after the completion of eradication treatment. At follow-up, the recurrence of gastric polyp was evaluated via esophagogastroduodenoscopy.

Results

Seventy-nine patients were enrolled. During the mean follow-up period of 16.4 months, the recurrence rate of gastric polyp was 25.3%. Among those who received H. pylori eradication therapy, the H. pylori persistent group showed a higher recurrence of polyp than the H. pylori eradicated group; but there was no statistical significance (42.9% vs. 21.7%, p=0.269). Regarding the final H. pylori infection status, the recurrence rate of gastric polyps was significantly higher in the H. pylori positive group than in the H. pylori negative group (42.9% vs. 18.9%, p=0.031). In multivariate analysis, the final H. pylori infection status was a significant risk factor for gastric polyp recurrence after endoscopic removal.

Conclusions

The final positive H. pylori infection status is significantly associated with higher recurrence of gastric hyperplastic polyps after endoscopic removal.

Keywords: Stomach neoplasms, Helicobacter pylori, Therapeutics, Recurrence

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Fig. 1.

Flow chart of this study. H. pylori, Helicobacter pylori; HP, Helicobacter pylori.

Fig. 2.

Comparison of gastric hyperplastic polyp recurrence according to HP eradication status (HP eradicated vs. HP persistent). HP, Helicobacter pylori.

Fig. 3.

Comparison of gastric hyperplastic polyp recurrence according to final HP status (HP negative status vs. HP positive status). HP, Helicobacter pylori.

Table 1.

Baseline Clinical Characteristics of Study Population according to H. pylori Infection

	H. pylori (−)(n=35)	H. pylori (+)(n=44)	p-value
Age (years)	64.7±12.7	60.4±11.5	0.073
Sex			0.512
Male	11 (31.4)	17 (38.6)
Female	24 (68.6)	27 (61.4)
Diabetes mellitus	6 (17.1)	11 (25.0)	0.405
Hypertension	14 (40.0)	17 (38.6)	0.903
Alcohol	8 (22.9)	15 (34.1)	0.281
Smoking	4 (11.4)	7 (15.9)	0.574

Values are presented as mean±standard deviation or n (%).

H. pylori, Helicobacter pylori.

Table 2.

Characteristics of Gastric Hyperplastic Polyps

	H. pylori (−)(n=35)	H. pylori (+)(n=44)	p-value
Size (mm)	11.5±6.0	12.7±7.2	0.503
Location			0.172
Antrum	11 (31.4)	19 (43.2)
Body	15 (42.9)	19 (43.2)
Cardia/fundus	s 9 (25.7)	6 (13.6)
Number			0.076
1	21 (60.0)	32 (72.7)
≥2	14 (40.0)	12 (27.3)

Values are presented as mean±standard deviation or n (%).

H. pylori, Helicobacter pylori.

Table 3.

Risk Factors of Gastric Hyperplastic Polyp Recurrence (Univariate and Multivariate Logistic Regression Analysis)

	Univariate analysis		Multivariate analysis
	OR (95% CI)	p-value	OR (95% CI)	p-value
Age (≥50)	1.63 (0.48–5.53)	0.430	1.51 (0.37–6.13)	0.562
Sex (male)	0.72 (0.24–2.15)	0.557	1.31 (0.30–5.61)	0.721
Diabetes mellitus	1.13 (0.32–3.97)	0.848
Hypertension	1.72 (0.58–5.09)	0.330	1.40 (0.42–4.63)	0.581
Alcohol	1.90 (0.56–6.46)	0.304	2.15 (0.45–10.2)	0.336
Smoking	0.89 (0.21–3.74)	0.872
Polyp size (≥10 mm)	0.56 (0.20–1.59)	0.275	1.32 (0.40–4.30)	0.650
Location of polyps
Non-antrum	1		1
Antrum	0.52 (0.17–1.63)	0.263	0.49 (0.13–1.84)	2.292
Polyp numbers
1	1
2–4	0.77 (0.24–2.48)	0.666
≥5	1.39 (0.12–16.6)	0.793
Initial HP positive status	2.26 (0.76–6.67)	0.141	1.66 (0.42–6.62)	0.474
Final HP positive status	0.31 (0.11–0.92)	0.035	0.28 (0.09–0.90)	0.033

OR, odds ratio; CI, confidence interval; HP, Helicobacter pylori.

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