Skip to main content
SpringerLink
Log in

Esophagogastroscopic Abnormalities Potentially Guided Patients Younger than 50 Years Old to Undergo Colonoscopy Earlier: A Retrospective Cross-Sectional Study

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background

The incidence of early-onset colorectal cancer (CRC) is continuously increasing worldwide. Current guidelines in China recommend average-risk individuals starting CRC screening at age 50.

Aims

To investigate the relationship between the gastric histopathology and colorectal neoplasms to identify CRC risk factors which potentially guide earlier colonoscopy in individuals aged < 50 years.

Methods

A retrospective cross-sectional study was conducted on 8819 patients younger than age 50 who underwent gastroscopy and colonoscopy simultaneously between November 7, 2020 and November 14, 2022. Multivariate logistic regression was used to evaluate whether various gastric histopathology are risk factors for different types of colorectal polyps, reporting odds ratios (ORs) with corresponding 95% confidence intervals (CIs).

Results

A total of 3390 cases (38.44%) under 50 years old were diagnosed as colorectal polyps. Advanced age (OR 1.66, 95%CI 1.57–1.76), male sex (OR 2.67, 95%CI 2.33–3.08), Helicobacter pylori (H. pylori) infection (OR 1.43, 95%CI 1.24–1.65), gastric polyps (OR 1.29, 95%CI 1.10–1.52), and low-grade intraepithelial neoplasia (LGIN) (OR 2.52, 95%CI 1.39–4.57) were independent risk factors for colorectal adenomas. For non-adenomatous polyps, reflux esophagitis (OR 1.38, 95%CI 1.11–1.71) was also an independent risk factor. Besides, older age (OR 1.90, 95%CI 1.66–2.18), male sex (OR 2.15, 95%CI 1.60–2.87), and H. pylori infection (OR 1.67, 95%CI 1.24–2.24) were associated with a higher risk of advanced neoplasms (advanced adenoma and CRC).

Conclusions

Earlier colonoscopy for identification and screening may need to be considered for individuals younger than 50 years old with H. pylori infection, LGIN, gastric polyps, and reflux esophagitis. Risk-adapted CRC screening initiation age allows a personalized and precise screening.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2021. CA Cancer J Clin. 2021;71:7–33.

    Article  PubMed  Google Scholar 

  2. Dekker E, Tanis PJ, Vleugels JLA, Kasi PM, Wallace MB. Colorectal cancer. Lancet. 2019;394:1467–1480.

    Article  PubMed  Google Scholar 

  3. Zauber AG, Winawer SJ, O’brien MJ et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med. 2012;366:687–696.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Chinese Society of Gastroenterology, Cancer Collaboration Group of Chinese Society of Gastroenterology, Chinese Medical Association. Chinese Consensus on Prevention of Colorectal Neoplasia (2021, Shanghai). J Dig Dis. 2022;23:58–90.

    Article  Google Scholar 

  5. Pan H, Zhao Z, Deng Y et al. The global, regional, and national early-onset colorectal cancer burden and trends from 1990 to 2019: results from the Global Burden of Disease Study 2019. BMC Public Health. 2022;22:1896.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Davidson KW, Barry MJ, Mangione CM et al. Screening for colorectal cancer: US Preventive Services Task Force Recommendation Statement. JAMA. 2021;325:1965–1977.

    Article  PubMed  Google Scholar 

  7. Dong X, Luo Z, Wu Z et al. Risk-adapted starting age for personalized colorectal cancer screening: validated evidence from national population-based studies. Clin Gastroenterol Hepatol. 2023;21:819-826.e813.

    Article  PubMed  Google Scholar 

  8. O’sullivan DE, Sutherland RL, Town S et al. Risk factors for early-onset colorectal cancer: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2022;20:1229-1240.e1225.

    Article  PubMed  Google Scholar 

  9. Sonnenberg A, Turner KO, Genta RM. Associations between gastric histopathology and the occurrence of colonic polyps. Colorectal Dis. 2020;22:814–817.

    Article  CAS  PubMed  Google Scholar 

  10. Feng L, Zhao K, Wang G et al. Relationship between endoscopic gastric abnormalities and colorectal polyps: a cross-sectional study based on 33439 Chinese patients. Int J Med Sci. 2023;20:219–224.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Ma K, Chen X, Xiang X et al. Willingness to undergo gastroscopy for early gastric cancer screening and its associated factors during the COVID-19 pandemic - a nationwide cross-sectional study in China. Patient Prefer Adherence. 2023;17:505–516.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Maes-Carballo M, García-García M, Martín-Díaz M et al. A comprehensive systematic review of colorectal cancer screening clinical practices guidelines and consensus statements. Br J Cancer. 2023;128:946–957.

    Article  PubMed  Google Scholar 

  13. Kolb JM, Hu J, Desanto K et al. Early-age onset colorectal neoplasia in average-risk individuals undergoing screening colonoscopy: a systematic review and meta-analysis. Gastroenterology. 2021;161:1145-1155.e1112.

    Article  CAS  PubMed  Google Scholar 

  14. Liang PS, Williams JL, Dominitz JA, Corley DA, Zauber AG. Age-stratified prevalence and predictors of neoplasia among U.S. adults undergoing screening colonoscopy in a national endoscopy registry. Gastroenterology. 2022;163:742–753.e744.

  15. Song M, Emilsson L, Bozorg SR et al. Risk of colorectal cancer incidence and mortality after polypectomy: a Swedish record-linkage study. Lancet Gastroenterol Hepatol. 2020;5:537–547.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Brenner H, Hoffmeister M, Arndt V, Haug U. Gender differences in colorectal cancer: implications for age at initiation of screening. Br J Cancer. 2007;96:828–831.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Chen X, Heisser T, Cardoso R, Hoffmeister M, Brenner H. Overall and age-specific risk advancement periods of colorectal cancer for men vs women: Implications for gender-sensitive screening offers? Int J Cancer. 2023.

  18. Li W, Zhang L, Jing Y, Yang Y, Wang Y. The potential value of gastric histopathology for predicting colorectal adenomatous polyps among the Chinese population: A Retrospective Cross-Sectional Study. Front Oncol. 2022;12:889417.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Butt J, Varga MG, Blot WJ et al. Serologic Response to Helicobacter pylori Proteins associated with risk of colorectal cancer among diverse populations in the United States. Gastroenterology. 2019;156:175-186.e172.

    Article  PubMed  Google Scholar 

  20. Luther J, Owyang SY, Takeuchi T et al. Helicobacter pylori DNA decreases pro-inflammatory cytokine production by dendritic cells and attenuates dextran sodium sulphate-induced colitis. Gut. 2011;60:1479–1486.

    Article  CAS  PubMed  Google Scholar 

  21. Kanno T, Matsuki T, Oka M et al. Gastric acid reduction leads to an alteration in lower intestinal microflora. Biochem Biophys Res Commun. 2009;381:666–670.

    Article  CAS  PubMed  Google Scholar 

  22. Cheng Y, Ling Z, Li L. The Intestinal Microbiota and Colorectal Cancer. Front Immunol. 2020;11:615056.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Thorburn CM, Friedman GD, Dickinson CJ, Vogelman JH, Orentreich N, Parsonnet J. Gastrin and colorectal cancer: a prospective study. Gastroenterology. 1998;115:275–280.

    Article  CAS  PubMed  Google Scholar 

  24. Cai Q, Gao YT, Chow WH et al. Prospective study of urinary prostaglandin E2 metabolite and colorectal cancer risk. J Clin Oncol. 2006;24:5010–5016.

    Article  CAS  PubMed  Google Scholar 

  25. Kountouras J, Zavos C, Chatzopoulos D, Katsinelos P. New aspects of Helicobacter pylori infection involvement in gastric oncogenesis. J Surg Res. 2008;146:149–158.

    Article  PubMed  Google Scholar 

  26. Abraham SC, Singh VK, Yardley JH, Wu TT. Hyperplastic polyps of the stomach: associations with histologic patterns of gastritis and gastric atrophy. Am J Surg Pathol. 2001;25:500–507.

    Article  CAS  PubMed  Google Scholar 

  27. Carmack SW, Genta RM, Schuler CM, Saboorian MH. The current spectrum of gastric polyps: a 1-year national study of over 120,000 patients. Am J Gastroenterol. 2009;104:1524–1532.

    Article  PubMed  Google Scholar 

  28. Islam MM, Poly TN, Walther BA et al. Adverse outcomes of long-term use of proton pump inhibitors: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol. 2018;30:1395–1405.

    Article  CAS  PubMed  Google Scholar 

  29. Zhang S, Zheng D, Yang Z et al. Patients with gastric polyps need colonoscopy screening at younger age: a large prospective cross-sectional study in China. J Cancer. 2019;10:4623–4632.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Kim NH, Park JH, Park DI, Sohn CI, Jung YS. Is colonoscopic screening necessary for patients younger than 50 years with gastric adenoma or cancer? J Korean Med Sci. 2017;32:1281–1287.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Sonnenberg A, Turner KO, Genta RM. Increased risk for colon polyps in patients with reflux disease. Dig Dis Sci. 2018;63:228–233.

    Article  PubMed  Google Scholar 

  32. Amano Y, Nakahara R, Yuki T et al. Relationship between Barrett’s esophagus and colonic diseases: a role for colonoscopy in Barrett’s surveillance. J Gastroenterol. 2019;54:984–993.

    Article  CAS  PubMed  Google Scholar 

  33. Deng SX, Gao J, An W et al. Colorectal cancer screening behavior and willingness: an outpatient survey in China. World J Gastroenterol. 2011;17:3133–3139.

    PubMed  PubMed Central  Google Scholar 

  34. Liang PS, Allison J, Ladabaum U et al. Potential intended and unintended consequences of recommending initiation of colorectal cancer screening at age 45 years. Gastroenterology. 2018;155:950–954.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 Wenhuaxi Road, Jinan, 250012, Shandong, China

    Zhongxue Han, Xinrui Guo, Cheng Peng, Wenlin Zhang, Xueping Nan, Meng Wan, Yueyue Li & Yanqing Li

  2. Laboratory of Translational Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 Wenhuaxi Road, Jinan, 250012, Shandong, China

    Zhongxue Han, Xinrui Guo, Cheng Peng, Wenlin Zhang, Xueping Nan, Meng Wan, Yueyue Li & Yanqing Li

  3. Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI Tumor, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 Wenhuaxi Road, Jinan, 250012, Shandong, China

    Zhongxue Han, Xinrui Guo, Cheng Peng, Wenlin Zhang, Xueping Nan, Meng Wan, Yueyue Li & Yanqing Li

Authors
  1. Zhongxue Han
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Xinrui Guo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Cheng Peng
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Wenlin Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Xueping Nan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Meng Wan
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yueyue Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yanqing Li
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yueyue Li.

Ethics declarations

Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

The study was approved by the Medical Ethics Committee of Qilu Hospital of Shandong University (Jinan, Shandong Province, China).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Han, Z., Guo, X., Peng, C. et al. Esophagogastroscopic Abnormalities Potentially Guided Patients Younger than 50 Years Old to Undergo Colonoscopy Earlier: A Retrospective Cross-Sectional Study. Dig Dis Sci 69, 36–44 (2024). https://doi.org/10.1007/s10620-023-08158-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-023-08158-y

Keywords

Search

Navigation