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Sirs,

We thank Dr Kountouras and colleagues for their interest in our article.[1, 2] The role of Helicobacter pylori in the development of peptic ulcers, as well as gastric adenocarcinomas and gastric mucosa-associated lymphomas (MALT lymphomas), is now widely accepted.[3] The idea that the same pathogen could be involved in the pathogenesis of both Barrett's oesophagus (BO) and colonic tumours is intriguing.

The recent findings by Zhang et al.[4] showing an adjusted odds ratio of 1.18 (95% CI: 1.01–1.38) between H. pylori infection and colorectal cancer points to a potential association between the two. Furthermore, a meta-analysis[5] of 13 studies from 2008 also showed a positive association, with an odds ratio of 1.49 (95% CI: 1.17–1.91). However, studies by Abbass et al.[6] (published after the meta-analysis by Zhao et al.[3] and therefore not included in the analysis) and Siddheshwar et al.[7] found no association.

Given the uncertainty at present, more studies are needed to confirm the relationship, should one exist, as well as a mechanistic explanation.

Acknowledgement

  1. Top of page
  2. Acknowledgement
  3. References

The authors’ declarations of personal and financial interests are unchanged from those in the original article.2

References

  1. Top of page
  2. Acknowledgement
  3. References
  • 1
    Kountouras J, Zavos C, Chatzopoulos D, et al. Letter: is Helicobacter pylori behind Barrett's oesophagus and colorectal neoplasms? Aliment Pharmacol Ther 2013; 37: 837.
  • 2
    Andrici J, Tio M, Cox MR, Eslick GD. Meta-analysis: Barrett's oesophagus and the risk of colonic tumours. Aliment Pharmacol Ther 2013; 37: 40110.
  • 3
    Eslick GD, Lim LL-Y, Byles JE, Xia HH-X, Talley NJ. Association of Helicobacter pylori infection with gastric carcinoma: a meta-analysis. Am J Gastroenterol 1999; 94: 23739.
    Direct Link:
  • 4
    Zhang Y, Hoffmeister M, Weck MN, Chang-Claude J, Brenner H. Helicobacter pylori infection and colorectal cancer risk: evidence from a large population-based case-control study in Germany. Am J Epidemiol 2012; 176: 5667.
  • 5
    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: 87582.
  • 6
    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: 4736.
  • 7
    Siddheshwar RK, Muhammad KB, Gray JC, Kelly SB. Seroprevalence of Helicobacter pylori in patients with colorectal polyps and colorectal carcinoma. Am J Gastroenterol 2001; 96: 848.
    Direct Link: