Gastric Mucosal Changes and Malignancy Risk in Helicobacter pylori Infection: A Histopathological Study

Abstract

Introduction: Helicobacter pylori infection is a well-established risk factor for chronic gastritis, peptic ulcer disease, and gastric malignancy. Histopathological examination of gastric biopsies remains the gold standard for detecting mucosal alterations associated with infection.

Objectives: To describe histopathological changes associated with H. pylori infection in gastric mucosal biopsies and to explore its correlation with premalignant and malignant lesions.

Methods: A descriptive study was conducted on 78 gastric biopsy specimens (43 H. pylori-positive, 35 negative) received in the Department of Pathology, Government Medical College, Thiruvananthapuram, between March 2014 and February 2015. Routine H&E and modified Giemsa stains were used. Chronic inflammation, neutrophilic activity, glandular atrophy, intestinal metaplasia, lymphoid follicles, eosinophilic infiltration, dysplasia, and carcinoma were assessed.

Results: Among 43 H. pylori-positive cases, marked chronic inflammation (23.3%), moderate to marked neutrophilic infiltration (65.1%), and intestinal metaplasia (44.2%) showed significant association with infection (p<0.05). Eosinophilic infiltration (93.0%) and lymphoid follicles (32.6%) were also significantly higher. Dysplasia (16.3%) and adenocarcinoma (6.9%) were more frequent in positive biopsies but not statistically significant (p>0.05).

Conclusions: H. pylori infection is strongly associated with chronic inflammation, neutrophilic activity, intestinal metaplasia, and immune-mediated mucosal changes. The presence of dysplasia and carcinoma in infected mucosa emphasizes the importance of early detection and eradication therapy to prevent malignant transformation.