〔Abstract〕 Objective To investigate the relationship between Type ⅠHelicobacter pylori (H. pylori) infection and the risk of colorectal neoplasms (CRN) in patients attending gastroenterology clinics, and to evaluate its predictive value for CRN in this population. Methods We included 2,148 patients presenting to the Department of Gastroenterology, with 677 assigned to the CRN group and 1,471 to the non-CRN group.H.pylori antibody typing was performed using Western blot, with type Ⅰ defined as positivity for CagA and/or VacA antibodies, and type II as positivity only for UreA/B antibodies. Statistical analyses included univariate screening, multivariate logistic regression, and receiver operating characteristic (ROC) curve evaluation. Results Type ⅠH.pylori seropositivity was significantly more prevalent in the CRN group than in the non-CRN group (54.51% vs 45.62%, P<0.0167). No significant differences were observed for type II H.pylorior seronegative subjects. The CRN group had higher proportions of males, hypertension, diabetes, smoking, and alcohol use, as well as elevated body mass index, fasting plasma glucose, triglycerides, and uric acid, along with lower high-density lipoprotein levels (all P<0.05). Multivariate analysis confirmed type Ⅰ H.pylori (OR=1.303), alcohol consumption (OR=2.315), male sex (OR=1.592), and age (OR=1.048) as independent risk factors for CRN. Although type I H.pylori alone showed limited predictive value (AUC=0.544), a combined model incorporating alcohol use, age, and sex demonstrated significantly improved discriminative ability (AUC=0.681, sensitivity 59.1%, specificity 68.2%). Conclusion Type ⅠH. pylori infection predicts the risk of CRN in gastroenterology patients. Assessing it can help to optimize the identification of high-risk individuals and inform targeted screening strategies.