No significant association between Helicobacter pylori infection and Barrett's esophagus: results from a large screening cohort in Central Europe.

BACKGROUND

Barrett's esophagus (BE) is a premalignant condition associated with gastroesophageal reflux disease (GERD) and an increased risk of esophageal adenocarcinoma (EAC). While Helicobacter pylori (H. pylori) has been proposed as a potential protective factor against BE, evidence remains conflicting, and clinical implications are uncertain. We aimed to investigate the association between H. pylori infection and BE in a largescreening cohort from Central Europe.

METHODS

We analyzed data from 4,074 asymptomatic participants who underwent upper endoscopy at a single center as part of a colorectal cancer screening between 2007 and 2020. BE was defined by endoscopic evidence and histologic confirmationof specialized intestinal metaplasia. H. pylori status was determined histologically;endoscopic classification of H. pylori-associated gastritis was not used due to non standardized assessment. Multivariable logistic regression examined the association, adjusting for demographic, metabolic, and lifestyle confounders; univariable models were descriptive.

RESULTS

BE prevalence was 1.2%, and H. pylori infection was present in 18.8% of participants, consistent with Austrian estimates (∼20%). No significant association was found between H. pylori infection and BE (adjusted OR 0.70, 95% CI 0.31-1.58, p = 0.395). Male sex (adjusted OR 3.45, 95% CI 1.66-7.20, p = 0.001) and active smoking (adjusted OR 2.15, 95% CI 1.02-4.54, p = 0.045) were the strongest independent predictors. Interaction analyses revealed no effect modification by age, sex, metabolic syndrome, or proton pump inhibitor use.

CONCLUSIONS

In this cohort, current H. pylori infection was not significantly associated with prevalent BE, and the adjusted effect estimate did not suggest a meaningful relationship.