Endoscopic and Histopathological Patterns of Gastric Adenocarcinoma with Reference to Helicobacter pylori Infection

Open Access

Abstract

Background: Gastric adenocarcinoma remains a leading cause of cancer-related mortality worldwide, with Helicobacter pylori recognized as the principal etiological agent. This study aimed to evaluate the endoscopic and histopathological patterns of gastric adenocarcinoma in relation to H. pylori infection. Methods & Materials: A hospital-based cross-sectional study was conducted on 56 patients with histologically confirmed gastric adenocarcinoma. All patients underwent upper gastrointestinal endoscopy with lesion classification according to the Paris classification. Biopsy specimens were examined for histopathological typing (Lauren and WHO classifications), precursor lesions, and H. pylori status using Giemsa staining. Associations between variables were analyzed using the Chi-square test, with p < 0.05 considered statistically significant. Results: The study included 36 males (64.3%) and 20 females (35.7%), with a mean age of 57.6 ± 11.4 years. H. pylori infection was detected in 38 patients (67.9%). Intestinal-type adenocarcinoma (69.6%) was more common than diffuse-type (30.4%). A significant association was observed between H. pylori infection and intestinal-type tumors (82.1% vs. 35.3%; p < 0.001). Superficial depressed lesions (Paris 0-IIc) were strongly associated with diffuse-type adenocarcinoma (71.4%; OR 12.5; p=0.006). Precursor lesions (chronic atrophic gastritis and intestinal metaplasia) were significantly more prevalent in H. pylori-positive patients (89.5% and 78.9%, respectively; p < 0.001). H. pylori-negative patients presented with more advanced disease (77.8% Stage III/IV vs. 50.0%; p=0.04) and poorly differentiated tumors (66.7% vs. 36.8%; p=0.03). Conclusion: H. pylori infection is strongly associated with intestinal-type gastric cancer, precursor lesions, and distal tumor location. Depressed endoscopic lesions predict diffuse-type adenocarcinoma. H. pylori-negative patients present with advanced disease, suggesting an aggressive pathway. These findings support H. pylori eradication for prevention and emphasize meticulous endoscopic surveillance.