Original Article Elmer ress J Clin Med Res • 2012;4(3):172-176 Association of Helicobacter Pylori Infection and Colon Cancer Alexandros Strofilasa, Emmanuel E Lagoudianakisa, d, Charalambos Seretisa, Apostolos Pappasb, Nikolaos Koronakisa, Dimitrios Keramidarisa, Ilias Koukoutsisa, Ioannis Chrysikosc, Ioannis Manourasb , Andreas Manourasb Abstract Background: Gastrin has been shown to exert carcinogenic effect to the epithelium of the colon. This study examines whether hy- pergastrinemia and H. pylori infection -especially infection by the CagA+ strain- are statistically associated with colorectal cancer and examine possible correlations with the colorectal cancer stage and lymph node metastasis. Methods: In this prospective case-control study, fasting serum samples from 93 consecutive patients with colorectal cancer treated in a university surgical clinic were preoperatively collected and se- rum levels of gastrin were measured. A group of 20 age matched hernia patients were used as controls. The pathology report of the specimens was documented and statistical analysis of the data where performed with the spss 17 statistical suite. Results: H. pylori IgG antibodies was reported in 66/93 (71%) in the colorectal cancer group and 13/20 patients in the control group (65%), the difference having non-statistical significance (P = n.s). The prevalence of cagA protein expression in the anti- H. pylori IgG+ patients were higher in the colorectal cancer group (56% positivity), when compared to the control group (38,4% positiv- ity) but the difference was not of statistical significance (P = n.s). The mean levels of serum gastrin levels in the two groups did not significantly differ (Ca group 51.1 ± 36.6 pg/mL vs Control 49.8 Manuscript accepted for publication March 13, 2012 aSecond Department of Surgery, 401 Army General Hospital, Athens, Greece bFirst Department of Propaedeutic Surgery, Hippocrateion Hospital, Athens Medical School, Athens, Greece cSecond Department of Surgery, 417 NIMTS-Nosileutiko Idrima Metohikou Tameiou Stratou (Military Veterans’ Fund Hospital), Athens, Greece dCorresponding author: Emmanuel E Lagoudianakis. Email: redemlag@yahoo.gr doi:10.4021/jocmr880w ± 17.6 P = n.s.). Patients with lymph node metastasis had higher serum gastrin levels than patients without metastasis and this differ- ence was statistically significant. (53.6 vs 41.06 pg/mL P = 0.025). Conclusions: Although the serum gastrin levels were not statisti- cally different between the TNM stages of our patient cohort, our data found that serum gastrin levels were significantly higher in pa- tients with lymph node metastasis. Whether gastrin is implicated in the ability of cancer cells to metastasize to the lymph nodes merits further research. Keywords: Gastrin; Colorectal cancer; Helicobacter pylori; Cag+ Introduction Helicobacter pylori infection and hypergastrinemia are considered to be related to the development of colorectal cancer. However, the results of previously conducted stud- ies showed controversial findings, not being able to either reject or clearly support a direct correlation between H. py- lori infection and/or elevated gastrin levels with colorectal carcinogenesis. H. pylori is recognized as a class I human carcinogen, according to the International Agency for Research on Can- cer [1]. Although, H. pylori infection has been causative associated with gastric carcinoma and lymphoma, its role in colorectal cancer development remains unclarified [2]. A possible pathogenetic mechanism involves the persis- tent H. pylori colonization and inflammation of the gastric mucosa, particularly when the H. pylori strains express the cytoxin-associated gene (CagA) which often results in the development of chronic atrophic gastritis and subsequently hypergastrinemia, through a reverse-feedback mechanism; hypergastrinemia is considered to be a possible risk factor for the development of colorectal cancer [3-5]. The aim of our case-control study is to examine whether hypergastrinemia and H. pylori infection -especially infec- tion by the CagA+ strain- are statistically associated with colorectal cancer and examine possible correlations with the colorectal cancer stage and lymph node metastasis. 172 Articles © The authors | Journal compilation © J Clin Med Res and Elmer Press™ | www.jocmr.org This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited