{
  "abstract": "Objective 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.Methods 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.Results 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).Conclusions 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.",
  "authors": [
    {
      "affiliations": [
        "General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University, Salzburg, Austria"
      ],
      "name": "Andreas Völkerer"
    },
    {
      "affiliations": [
        "General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University, Salzburg, Austria"
      ],
      "name": "Sarah Wernly"
    },
    {
      "affiliations": [
        "Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria"
      ],
      "name": "Georg Semmler"
    },
    {
      "affiliations": [
        "Institute of General Practice, Family Medicine and Preventive Medicine",
        "Center for Public Health and Healthcare Research, Paracelsus Medical University, Salzburg, Austria"
      ],
      "name": "Maria Flamm"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, Elisabethinen Hospital Klagenfurt, Klagenfurt, Austria",
        "First Department of Medicine, University Clinic Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria"
      ],
      "name": "Mathias Ausserwinkler"
    },
    {
      "affiliations": [
        "Cancer Cluster Salzburg (CCS), Salzburg, Austria",
        "Department of Biosciences and Medical Biology, Paris Lodron University of Salzburg, Salzburg, Austria"
      ],
      "name": "Jutta Horejs-Hoeck"
    },
    {
      "affiliations": [
        "General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University, Salzburg, Austria"
      ],
      "name": "Anabel Berger"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, Saint John of God Hospital, Salzburg, Austria"
      ],
      "name": "Hannah Hofer"
    },
    {
      "affiliations": [
        "First Department of Medicine, University Clinic Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria"
      ],
      "name": "Elmar Aigner"
    },
    {
      "affiliations": [
        "General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University, Salzburg, Austria"
      ],
      "name": "Christian Datz"
    },
    {
      "affiliations": [
        "Institute of General Practice, Family Medicine and Preventive Medicine",
        "Center for Public Health and Healthcare Research, Paracelsus Medical University, Salzburg, Austria",
        "First Department of Medicine, University Clinic Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria"
      ],
      "name": "Bernhard Wernly"
    }
  ],
  "title": "Association between Helicobacter pylori infection and colonic diverticulosis: a retrospective observational study in an asymptomatic Austrian endoscopy-based screening cohort",
  "uid": "0d3e84cb-a5fd-5920-b80d-d22e3bd2da03"
}