Pre-malignant Gastric Lesions in Young Adults: The Impact of Chronic Helicobacter pylori Infection

Aims Helicobacter pylori (HP) infection is the most prevalent bacterial infection globally, affecting over half of the population. In economically disadvantaged regions, transmission often begins in childhood, which can lead to the development of high-risk precancerous lesions. This study aims to characterize gastric pre-neoplastic lesions in individuals under 40 years old infected with HP and to identify additional contributing factors beyond the infection itself.

Methods This descriptive retrospective study was conducted from February to July 2024. We included all patients under 40 who underwent endoscopic consultations and had gastric biopsy specimens analyzed according to the Sydney protocol. Atrophy was classified using the OLGA system, while metaplasia was classified using the OLGIM system. Patients with HP-negative biopsies were excluded. Data on demographics, clinical symptoms, endoscopic findings, and pathology were recorded in SPSS software

Results A total of 103 patients were included, with a mean age of 30 years (SD=10.40) and a male-to-female ratio of 0.8. Among the participants, 17.4% (n=18) were chronic smokers, 53% (n=54) reported symptoms of chronic gastroesophageal reflux disease (GERD), and 47.5% (n=49) tested positive for HP serology. The indications for upper gastrointestinal endoscopy included chronic epigastric pain (49%, n=47), isolated GERD (12%, n=11), chronic diarrhea (13%, n=12), and chronic vomiting (9%, n=9). Endoscopic findings showed erythematous pangastritis without atrophy in 58% (n=31) of patients, atrophic pangastritis in 15% (n=8), and isolated atrophy in the antrum (13%, n=7) and fundus (8%, n=4). Histological analysis revealed atrophy in 45.6% (n=47) of patients, predominantly affecting the antrum (78.7%). Among these, eleven patients had moderate atrophy, while 16 patients had fundic atrophy, with 8 classified as moderate. According to the OLGA classification, atrophy was staged as follows: Stage I (n=30), Stage II (n=14), and Stage III (n=3). Only 5 patients exhibited metaplasia, all classified as mild, except for one patient with moderate metaplasia. A slight correlation was observed between male gender and the severity of metaplasia (p=0.183), and a positive correlation was noted between age and the severity of atrophy (p=0.141

Conclusions Despite a high prevalence of pre-neoplastic lesions in our study population, the incidence of lesions with progressive risk (Stages III/IV) remains reassuring among young individuals. Further research is needed to explore the long-term implications of these findings.

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Artikel online veröffentlicht:
27. März 2025