Article | Published:

Helicobacter pylori Infection Is Associated With Reduced Risk of Barrett’s Esophagus: An Analysis of the Barrett’s and Esophageal Adenocarcinoma Consortium

The American Journal of Gastroenterologyvolume 113pages11481155 (2018) | Download Citation

Subjects

Abstract

Objectives

Epidemiological studies of Helicobacter pylori infection and risk of Barrett’s esophagus (BE) have reported conflicting results. We examined the association between H. pylori infection and BE and sought to determine whether the association is mediated by gastroesophageal reflux disease (GERD) and to identify potential effect modifiers.

Methods

We used individual level data from 1308 patients with BE (cases), 1388 population-based controls, and 1775 GERD controls in the Barrett’s and Esophageal Adenocarcinoma Consortium (BEACON). We estimated study-specific odds ratios (ORs) and 95% CIs using multivariable logistic regression models and obtained summary risk estimates using a random-effects meta-analytic approach. We examined potential effect modification by waist-to-hip ratio (WHR), body mass index (BMI), and smoking status by conducting stratified analyses.

Results

For comparisons with population-based controls, H. pylori infection was inversely associated with the risk of BE (adjusted OR = 0.44, 95% CI = 0.36-0.55), with no evidence of between-study heterogeneity (I2 = 0%). A stronger inverse association between H. pylori and BE was observed among individuals with the CagA-positive strain (P for interaction = 0.017). We found no evidence of interaction between WHR, BMI, smoking status, and H. pylori infection on the risk of BE. There was no association between H. pylori infection and BE for comparisons with GERD controls (OR = 0.96, 95% CI = 0.67-1.37; I2 = 48%).

Conclusions

This study provides the strongest evidence yet that H. pylori infection is strongly inversely associated with BE. This effect is probably mediated by a decrease in GERD in infected patients, since the protective effect disappears in patients with GERD symptoms.

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Author information

Affiliations

  1. Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, TX, USA

    • Zhensheng Wang MPH, PhD
    •  & Aaron P. Thrift PhD
  2. Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, NC, USA

    • Nicholas J. Shaheen MD, MPH
  3. QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia

    • David C. Whiteman MBBS, PhD
  4. Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland

    • Lesley A. Anderson PhD, MPH
  5. Program in Epidemiology, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    • Thomas L. Vaughan MD, MPH
  6. Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA

    • Douglas A. Corley MD, PhD
  7. San Francisco Medical Center, Kaiser Permanente Northern California, San Francisco, CA, USA

    • Douglas A. Corley MD, PhD
  8. Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA

    • Hashem B. El-Serag MD, MPH
  9. Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E DeBakey Veterans Affairs Medical Center, Houston, TX, USA

    • Hashem B. El-Serag MD, MPH
  10. Center for Clinical Management Research, Ann Arbor Veterans Affairs Medical Center, Ann Arbor, MI, USA

    • Joel H. Rubenstein MD, MSc
  11. Barrett’s Esophagus Program, Division of Gastroenterology Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA

    • Joel H. Rubenstein MD, MSc
  12. Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA

    • Aaron P. Thrift PhD

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Guarantor of the article

Aaron P. Thrift, PhD.

Specific author contributions

ZW and APT contributed to data analysis, interpretation of data, and drafting of the manuscript. NJS, DCW, LAA, TLV, DAC, HBE-S, and JHR designed the study; obtained funding; collected data from individual case–control studies; and contributed to the concept of the consortium, interpretation of data, and refinement of the manuscript. All authors approved the final draft submitted.

Financial support

This work was supported by the National Institutes of Health RO1 DK63616 (to DAC), 1R21DK077742 (to NJS and DAC), K23DK59311 (to NJS), R03 DK75842 (to NJS), K23DK079291 (to JHR), R01 CA116845 (to HBE-S), K24-04-107 (to HBE-S); an Ireland–Northern Ireland cooperation research project grant sponsored by the Northern Ireland Research and Development Office and the Health Research Board, Ireland (FINBAR) (RES/1699/01N/S); the Study of Digestive Health, NCI RO1 CA 001833 (to DCW); the Established Investigator Award in Cancer Prevention and Control, K05 CA124911 (to TLV), and the US Department of Veterans Affairs CSRD Merit I01-CX000899 (to JHR). ZW is supported by a Research Training Grant from the Cancer Prevention and Research Institute of Texas (CPRIT; RP160097).

Potential competing interests

None.

Corresponding author

Correspondence to Aaron P. Thrift PhD.

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DOI

https://doi.org/10.1038/s41395-018-0070-3

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