Histopathological Findings in Adult Patients With Dyspepsia and Their Association With Helicobacter pylori Infection

Helicobacter pylori infection is prevalent among Saudi adults and has been linked to gastric cancer and other tumor-like conditions. We aimed to explore the pathological characteristics of endoscopic gastric biopsies among symptomatic adult Saudi patients and their relation to H. pylori infection.

Among 151 gastric biopsies, gastritis was detected in 97 (64.2%) cases, chronic active gastritis in 26 patients (17.2%), duodenitis in 20 (13.2%) patients, and total metaplasia in 14 (9.3%) patients. H. pylori was detected in 83 cases (55%), with a recurrence or reinfection rate of 9.8%. The patients with H. pylori infection were considerably young (median age: 34 (IQR: 15) vs. 35.5 (IQR: 11), p = 0.024) and had a low frequency of epigastric pain (78.3% vs. 91.2%, p = 0.031), reflux/regurgitation (7.2% vs. 20.6%, p = 0.016), and dysphagia (4.85% vs. 14.7%, p = 0.037). However, they exhibited a higher incidence of chronic active gastritis (96.2% vs. 3.8%, p < 0.001) and intestinal metaplasia (85.7% vs. 14.3%, p = 0.015). Young age (OR = 1.09, 95% CI = 1.02-1.16, p = 0.011) and H. pylori infection (OR = 30.85, 95% CI = 3.26-291.60, p = 0.003) were identified as a positive predictor of intestinal metaplasia while heartburn (OR = 0.08, 95% CI = 0.01-0.58, p = 0.012) was a negative predictor.

H. pylori infection is prevalent among Saudi adults experiencing upper gastrointestinal symptoms and is associated with intestinal metaplasia. Infection rate and intestinal metaplasia were higher in patients with milder symptoms. Therefore, screening for H. pylori is highly recommended for Saudi individuals with upper gastrointestinal symptoms. Old age and H. pylori infection were identified as positive predictors of intestinal metaplasia, emphasizing the importance of early detection and management of H. pylori infection in the Saudi population.