Sex-Specific Associations of Helicobacter pylori Seropositivity and Intestinal Metaplasia with Colorectal Adenoma: A Korean Multicenter Cross-Sectional Study.

PURPOSE: Male sex is a recognized risk factor for colorectal adenoma, yet whether the associations of Helicobacter pylori, atrophic gastritis (AG), and intestinal metaplasia (IM) with colorectal adenoma differ by sex remains unclear. This study evaluated the sex-stratified and combined associations of anti-H. pylori IgG seropositivity, AG, and IM with conventional colorectal adenoma. MATERIALS AND METHODS: This multicenter cross-sectional study included 806 participants from a Korean health-screening cohort who underwent gastroscopy with H. pylori testing and colonoscopy within 3 years. Anti-H. pylori IgG seropositivity was determined by enzyme-linked immunosorbent assay, AG and IM were assessed endoscopically. Multivariable logistic regression models were adjusted for age, sex, body mass index, smoking, and alcohol consumption. RESULTS: Colorectal adenoma was identified in 209 participants (25.6%). Anti-H. pylori IgG seropositivity was independently associated with colorectal adenoma (adjusted odds ratio [aOR], 1.848; 95% confidence interval [CI], 1.323 to 2.581; p<0.001). AG was not significant after adjustment. IM was independently associated in a separate model (aOR, 1.648; 95% CI, 1.125 to 2.415; p=0.010), but showed only borderline significance in the combined model when including H. pylori seropositivity (aOR, 1.440; 95% CI, 0.973 to 2.131; p=0.068), whereas anti-H. pylori IgG seropositivity remained significant. Participants with both H. pylori seropositivity and IM showed the highest odds of colorectal adenoma. In sex-stratified analyses, anti-H. pylori IgG seropositivity was independently associated in males (aOR, 1.811; 95% CI, 1.147 to 2.860; p=0.011) but not in females, whereas IM was independently associated in females (aOR, 2.086; 95% CI, 1.129 to 3.856; p=0.019) but not in males. Formal interaction tests were not statistically significant. CONCLUSIONS: Anti-H. pylori IgG seropositivity and IM were associated with conventional colorectal adenoma, whereas AG was not significant after adjustment. Sex-stratified analyses suggested potential sex-related patterns, with H. pylori seropositivity appearing more prominent in males and IM appearing more prominent in females.