Association between Helicobacter pylori infection and colonic diverticulosis: a retrospective observational study in...

Colonic diverticulosis is highly prevalent in ageing populations, yet the role of microbial factors remains unclear. Helicobacter pylori (HP) exerts systemic and microbiome-modulating effects and has been linked to extragastric inflammatory states, rendering an association with diverticulosis biologically plausible. However, this hypothesis has not been examined in asymptomatic screening populations with simultaneous endoscopic diverticulosis classification and histological HP confirmation. This study aimed to investigate whether HP infection is associated with colonic diverticulosis in an asymptomatic Austrian screening cohort.

We performed a retrospective observational study of 5646 asymptomatic adults undergoing screening colonoscopy with concurrent oesophagogastroduodenoscopy (2007-2020). Diverticulosis was classified endoscopically by distribution; HP status was determined histologically from gastric biopsies. Multivariable logistic regression adjusted for metabolic, sociodemographic and lifestyle factors. A subset with follow-up colonoscopy (n=510) was analysed descriptively.

Diverticulosis was present in 37% of participants and HP infection in 19%. No association was found between HP infection and diverticulosis in univariable (OR 1.01, 95% CI 0.88 to 1.15; p=0.935) or fully adjusted analysis (OR 0.86, 95% CI 0.72 to 1.02; p=0.078), with an effect size too small to be clinically meaningful. Subgroup analyses by diverticular distribution and interaction analyses across age, sex, metabolic syndrome and lifestyle factors showed consistent null results. In the longitudinal subset, diverticulosis prevalence at follow-up did not differ by baseline HP status (63.9% vs 62.1%; p=0.749).

In this large screening cohort with simultaneous endoscopic and histological confirmation, HP infection was not associated with colonic diverticulosis across subtypes or risk strata. These findings do not support HP status as a clinically useful marker of asymptomatic diverticulosis. In future microbiome-focused studies of diverticulosis, HP infection may be best regarded as a potential confounder or marker of broader host, socioeconomic or healthcare-related factors.