Abstract

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.