Helicobacter pylori infection, treatment and colorectal cancer risk by genetic predisposition: evidence from two randomised trials.

H. pylori–positive individuals had higher incident colorectal cancer risk than H. pylori–negative individuals in two randomized trial cohorts, with HR=2.96 in SIT and HR=1.27 in MITS.

• Why it matters: Prior evidence linking H. pylori infection to colorectal cancer risk is uncertain, and it is unclear whether host genetic susceptibility and bacterial virulence modify any association.
• What they did: Using two randomized trial cohorts (SIT n=3365; MITS n=180 284) plus a MITS case-cohort analysis, investigators related seropositivity for H. pylori antigens and Polygenic Risk Score deciles to incident CRC.
• The result: In SIT, H. pylori treatment reduced CRC risk over 29.4 years (HR=0.47), especially with successful eradication (HR=0.38), while in MITS overall benefit was not seen 13.8 years after treatment (HR=1.17).

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