Prevalence and Predictive Factors of Gastric Atrophy and Intestinal Metaplasia in Helicobacter pylori-Associated Gastritis

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Aims Gastric atrophy and intestinal metaplasia are precancerous lesions that can progress to gastric cancer. The progression of histological abnormalities induced by Helicobacter pylori (HP) towards these two lesions depends on certain factors related to the bacteria itself, the host, and environmental factors. The aim of this study is to evaluate the prevalence and factors associated with gastric atrophy and intestinal metaplasia in patients infected with HP. Methods This is a single-center retrospective study conducted over a 15-month period, involving all patients diagnosed with Helicobacter pylori infection through gastric biopsies. The histological characteristics of chronic gastritis were assessed according to the Sydney classification. Results We included 300 patients with a mean age of 51 years [10-82] and a male-to-female sex ratio of 0.8. Gastric atrophy was found in 24.7% of patients (n=74). It was mild in 44.3%, moderate in 38.6%, and severe in 17%. The antrum was the most common location (64.9%). In multivariate analysis, gastric atrophy was significantly associated with an age over 40 years (p=0.027). In our study, atrophy was not related to the density of colonization by HP or the severity of gastritis activity (p=0.07, p=0.36). Intestinal metaplasia was present in 33 patients with a prevalence of 11%. The antrum was the most frequent location (63.3%). The correlation study revealed that metaplasia was significantly associated with an age over 40 years and severe atrophy (p=0.002, p<0.001). Conclusions Intestinal metaplasia and atrophy were significantly associated with an age over 40 years, emphasizing the need for increased vigilance in these patients. The lack of correlation between HP colonization density and these lesions could explain their persistence after bacterial eradication. Publication History Article published online: 15 April 2024 © 2024. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

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