H. pylori and LRG1 protein predict colon polyp return

Getting a colon polyp removed is not the end of the story. Roughly one in four patients grows a new one within a year, and doctors have had few reliable ways to tell in advance who is in that group. A new study out of China points to two overlooked signals, one already in your gut and one hiding in the tissue that gets thrown away after surgery, that together sort high-risk patients from low-risk ones with striking accuracy.

Key takeaways

• Patients infected with Helicobacter pylori (H. pylori, the stomach bacterium linked to ulcers) were more than 2.5 times as likely to have their colon polyps come back within a year.
• Higher levels of a protein called LRG1 in the removed polyp tissue itself, not blood, also independently predicted recurrence.
• A prediction model combining both markers with three other factors reached a C-index of 0.85, a strong discrimination score for a clinical risk tool.
• The findings are preliminary: single hospital, no outside validation yet, and no data on which H. pylori strains were involved.

H. pylori infection and tissue LRG1 levels independently predict colon polyp recurrence

Researchers writing in the International Journal of General Medicine found that two factors, an active H. pylori infection and elevated levels of the protein LRG1 (leucine-rich alpha-2-glycoprotein 1, a molecule involved in blood vessel growth and inflammation) inside the polyp tissue itself, each independently raised the odds that a colon polyp would recur after removal. Patients who went on to have a new polyp were H. pylori-positive 68.49% of the time, compared with 38.80% of patients who stayed polyp-free. Tissue LRG1 followed the same pattern: a median of 66.44 ng/mL in the recurrence group versus 46.41 ng/mL in those without regrowth.

What this means for people who have had colon polyps removed

Colon polyps matter because some of them, particularly the neoplastic type (abnormal tissue growth with cancer potential), are the starting point for colorectal cancer. Standard care after removal already includes follow-up colonoscopy, but current guidelines schedule those visits mostly by polyp size, number, and pathology type, not by a patient's infection status or local tissue biology. If H. pylori and LRG1 hold up as recurrence markers in larger studies, they could give gastroenterologists a way to flag which patients need closer monitoring and which can safely wait longer between scopes, a distinction that affects both cancer risk and the burden of repeat procedures.

A prospective cohort of 256 patients tracked for a year after removal

The study followed 256 patients who underwent endoscopic mucosal resection (EMR, a minimally invasive technique for removing polyps through a colonoscope) at a single hospital in Zhejiang, China, between March 2020 and March 2023. Researchers tested every patient for H. pylori using a breath test and measured LRG1 directly in the resected polyp tissue rather than in blood, reasoning that tissue-level readings would more closely reflect what is happening at the site of disease. Patients then had a colonoscopy every three months for a full year to check for new growths. Of the 256 patients, 73 developed a recurrence and 183 did not. The researchers used statistical modeling (multivariable Cox regression, a method for weighing several risk factors against each other over time) to confirm that H. pylori and LRG1 predicted recurrence independently of other known risk factors like family history, polyp count, polyp size, and tissue type.

What the numbers actually mean for individual risk

In the statistical model, H. pylori infection nearly tripled recurrence risk, with a hazard ratio of 2.575 (meaning infected patients faced roughly two and a half times the risk of non-infected patients, holding other factors equal). LRG1's effect was smaller per unit but still significant, with each one-unit rise in tissue LRG1 level associated with about a 3.1% increase in recurrence risk. Family history of colorectal cancer, having more polyps, larger polyp size, and neoplastic (as opposed to non-neoplastic) polyp type also independently raised risk. When the researchers combined all five factors into a single scoring tool, called a nomogram (a chart that converts several risk factors into one composite score), it correctly ranked higher-risk and lower-risk patients 85% of the time, an unusually strong result for this kind of prediction. This is not yet a tool a doctor can plug into everyday practice, but it is worth asking your own gastroenterologist whether H. pylori testing factors into your post-polyp follow-up plan, especially if you have other risk factors like a family history of colorectal cancer.

A single-center, unvalidated model with several open questions

The authors themselves flagged the study's most important limits. Everyone was treated at one hospital, so the results have not been confirmed at other centers or in other populations. The prediction model was tested using bootstrap resampling (a statistical technique that resamples the same dataset repeatedly rather than testing on new patients), meaning it still lacks true external validation. The researchers also did not analyze which specific strains of H. pylori were involved, so it is not clear whether more aggressive bacterial strains drive more of the risk, or whether resistant infections that persist despite treatment are inflating the numbers. Follow-up was capped at 12 months, which likely missed later recurrences. And despite finding that both factors mattered independently, the study did not test whether H. pylori and LRG1 interact with or amplify each other, a question the sample size (73 recurrence cases) was too small to answer reliably.

Multicenter validation is the next required step

Before H. pylori status or tissue LRG1 could enter routine colonoscopy follow-up decisions, the model needs to be tested in larger, multi-hospital cohorts with longer observation windows, ideally with H. pylori strain typing included. The authors note that measuring LRG1 in tissue supernatant is technically involved, so a practical, clinic-ready version of this test would also need simplification before it could scale beyond a research lab. No timeline for a follow-up trial was given in the paper.

Common Questions

Does treating H. pylori after a polyp is removed lower recurrence risk? This study did not test that question. It only showed an association between existing infection and recurrence, not whether eradicating the bacteria afterward changes outcomes.

Should I ask for an H. pylori breath test if I've had a polyp removed? It is a reasonable question to raise with your gastroenterologist, especially if you have other risk factors, but this single study is not yet strong enough evidence to change standard screening guidelines on its own.

Is LRG1 a blood test I can get right now? No. The study measured LRG1 directly in polyp tissue collected during the resection procedure, not in blood, and this is a research assay rather than a routine clinical test.

References

Yinhong Yu, Dongdong Lu, Fangxu Ye (2026). Polyp Tissue LRG1 Protein Levels and Helicobacter pylori Infection as Independent Predictors for Colonic Polyp Recurrence. International Journal of General Medicine. https://doi.org/10.2147/ijgm.s607521