Association between H. pylori infection status, UBT-derived DOB level, and colorectal polyp detection

To investigate the associations of Helicobacter pylori (H. pylori) infection status and urea breath test-derived delta over baseline (DOB) values with colorectal polyp detection, and DOB-related associations among H. pylori-positive participants.

This single-center ambispective observational study included 439 adults who underwent both a ¹³C-urea breath test (¹³C-UBT) and total colonoscopy during the same diagnostic workup at our hospital between January 2023 and December 2024. H. pylori positivity was defined as a DOB value ≥4.0‰. The primary outcome was colorectal polyp detection, and adenomatous polyps were analyzed as a secondary outcome. Logistic regression models were used in the unmatched cohort, and generalized estimating equation models were applied after one-to-one propensity score matching. Additional analyses were performed among H. pylori-positive participants using ln(DOB) and DOB quartiles. Exploratory receiver operating characteristic analysis was performed in the unmatched cohort.

In the unmatched cohort, the detection rate of colorectal polyps was higher in the H. pylori-positive group than in the H. pylori-negative group. After propensity score matching, 144 matched pairs were obtained, and the detection rate remained higher in the H. pylori-positive group (68.75% vs 52.78%). In the unmatched cohort, H. pylori positivity was associated with higher odds of colorectal polyp detection after multivariable adjustment (OR = 4.05, 95% CI: 2.60-6.30, P<0.001). In the matched cohort, this association persisted in generalized estimating equation models (adjusted OR = 1.91, 95% CI: 1.19-3.07, P = 0.005). Higher DOB levels were associated with colorectal polyp detection in unmatched and matched analyses. Among H. pylori-positive participants, ln(DOB) and higher DOB quartiles were associated with increased odds of colorectal polyp detection. Adenomatous polyps were more frequently detected in the H. pylori-positive group (50.00% vs 35.42%, P = 0.017). Exploratory ROC analysis showed an AUC of 0.713.

In this single-center ambispective cohort, H. pylori positivity and higher urea breath test-derived DOB values were associated with increased odds of colorectal polyp detection. Similar DOB-related associations were observed among H. pylori-positive participants, and adenomatous polyps were more frequently detected in the positive group. However, DOB alone showed limited discriminatory ability, and these findings require validation in larger multicenter studies.