Association of Helicobacter pylori infection with the correa cascade: a single-center, retrospective cohort study

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Background Helicobacter pylori ( H. pylori ) is a primary etiological agent for various gastric pathologies. Although numerous studies have described the association between H. pylori and individual stages of the Correa cascade, data comprehensively evaluating its prevalence across the full histopathological spectrum-from non-atrophic gastritis (NAG) to gastric cancer (GC)-within a single Chinese cohort remain limited. This study aimed to investigate the association between H. pylori infection and specific endoscopic stages, and further analyzed its influence on histopathological progression in a longitudinal sub-cohort. Methods A retrospective study was conducted using data from participants who underwent concurrent gastroscopy and a 14 C-Urea breath test (UBT) at the endoscopy center at Fengqing people’s Hospital between January 2019 and December 2024. Gastric mucosa status was assessed based on endoscopic and histopathological biopsy findings. Statistical associations were evaluated using the chi-square test. Correlations were analyzed using Spearman coefficients. A longitudinal sub-cohort was analyzed to compare disease progression between baseline H. pylori -positive and -negative groups. The hazard ratio (HR) and 95% confidence interval (CI) for incident disease progression were calculated by Cox proportional hazards regression. Results A total of 13,579 participants were included, and the overall prevalence of H. pylori infection was 62.54%. A statistically significant association was found between H. pylori infection and gastric sequential stages of Correa’s cascade. The infection rate varied across pathological groups, being highest in participants with low-grade intraepithelial neoplasia (LGIN) (77.46%), and lowest in those with non-atrophic gastritis (NAG) (61.05%). In the longitudinal sub-cohort, the disease progression rate was higher among participants who were H. pylori -positive at baseline compared to their negative counterparts (9.67% vs. 5.60%, p = 0.0043). The HR for disease progression was significantly increased among H. pylori-positive participants compared with H. pylori-negative participants after sex- and age-adjustment [adjusted HR = 1.60 (1.07-2.39), p=0.021]. Conclusion Our study reveals a significant association between H. pylori infection and advanced gastric lesions, and confirms its significant impact on disease progression. This evidence solidifies the importance of eradication in clinical management to halt disease advancement.

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