Helicobacter pylori (H. pylori) infects about half of the world’s population and can lead to premalignant lesions and gastric cancer. Updated data about the correlation of histopathological diagnostics with endoscopic diagnostics are scarce. The objective of this study was to identify the concordance between endoscopic and histopathologic findings, with a focus on premalignant lesions. We performed a cross sectional, retrospective study over a 4-year period (2017–2021) on adult patients with dyspeptic symptoms and positive RUT (rapid urease test) in a single hospital centre, with a total of 133 patients infected with H. pylori being included in the study. Statistical associations between endoscopic appearance and histopathological results were found for atrophic antral gastritis (p = 0.001), intestinal metaplasia of the antrum (p = 0.018), gastric polyps (p < 0.001) and gastric corpus cancer (p = 0.012). Females were more likely to be diagnosed through endoscopy with gastric atrophy or intestinal metaplasia (p = 0.031), while chronic atrophic gastritis in corpus was more prevalent in patients older than 65 (p = 0.024). Overall, our study reveals only 21% concordance between Giemsa stain and RUT, highlighting the importance of combining rapid testing with endoscopic and histopathological diagnostic methods for a more accurate early diagnosis and prevention of gastric cancer.

The importance of H. pylori infection in the development of non-alcoholic fatty liver disease, liver fibrosis, cirrhosis, insulin resistance, and non-alcoholic steatohepatitis has been shown in earlier studies. Our work aims to assess the risk of developing hepatic fibrosis in patients with or without H. pylori, using noninvasive scores such as the APRI index, the BARD score, or the FIB-4 index, and to evaluate a possible association between the severity of fibrosis scores and histopathology evidence (such as chronic gastritis, gastric atrophy, gastric metaplasia, and gastric dysplasia). Moreover, the risk of preneoplastic stomach lesions was assessed in patients with hepatic fibrosis. The study enrolled a total of 110 patients: 65 were H. pylori-positive and 45 were negative. The differences in BARD, APRI, and FIB-4 indexes between H. pylori-positive and negative cases were assessed using the Mann–Whitney test. Noticeably higher BARD scores and APRI indexes were observed when comparing H. pylori-positive patients with NAFLD to H. pylori-negative ones. In terms of the FIB-4 index, an insignificant increase was observed in H. pylori-positive versus H. pylori-negative patients. Multiple linear regression was performed for the BARD scores and APRI indexes, revealing further significant associations with age and H. pylori status. A substantial correlation was demonstrated between H. pylori and elevated hepatic fibrosis scores in individuals with NAFLD and gastritis, suggested by the complexity features of infection and the intricacies of histology.