The current infection with Helicobacter pylori and association with upper gastrointestinal lesions and risk of upper gastrointestinal cancer: Insights from multicenter population‐based cohort study

Abstract The relationship between Helicobacter pylori ( H. pylori ) infection and upper gastrointestinal (UGI) cancers is complex. This multicenter, population‐based cohort study conducted in seven areas in China aimed to assess the correlation between current H. pylori infection and the severity of UGI lesions, as well as its association with the risk of gastric cancer (GC) and esophageal cancer (EC). From 2015 to 2017, 27,085 participants (aged 40–69) completed a standardized questionnaire, and underwent a 13 C‐urea breath test. Then a subset underwent UGI endoscopy to assess the UGI lesion detection rates. All individuals were followed up until December 2021 to calculate the hazard ratios (HRs) for UGI cancers. H. pylori infection prevalence was 45.9%, and among endoscopy participants, 22.2% had gastric lesions, 19.2% had esophageal lesions. Higher detection rates of gastric lesions were noted in the H. pylori ‐positive population across all lesion severity levels. Over a median follow‐up of 6.3 years, 104 EC and 179 GC cases were observed, including 103 non‐cardia gastric cancer (NCGC) cases and 76 cardia gastric cancer (CGC) cases. H. pylori ‐infected individuals exhibited a 1.78‐fold increased risk of GC (HR 1.78, 95% confidence interval [CI] 1.32–2.40) but no significant increase in EC risk (HR 1.07, 95% CI 0.73–1.57). Notably, there was a higher risk for both NCGC and CGC in H. pylori ‐infected individuals. This population‐based cohort study provides valuable evidence supporting the association between current H. pylori infection and the risk of both NCGC and CGC. These findings contribute to the empirical basis for risk stratification and recommendations for UGI cancer screening.