Delayed Diagnosis and Evolving Trends in Gastric Cancer During and After COVID-19: A Comparative Study of Staging, Helicobacter pylori Infection and Bleeding Risk in Western Romania

<b>Background and Objectives:</b> Gastric cancer (GC) remains a leading cause of cancer mortality worldwide, and the COVID-19 pandemic posed new barriers in diagnosis and management. This study aimed to assess whether pandemic-related healthcare disruptions resulted in more advanced GC stages at presentation. We additionally examined the role of <i>Helicobacter pylori</i> (<i>H. pylori</i>) across non-cardia GC (NCGC) versus cardia GC (CGC) and evaluated the risk factors of upper gastrointestinal (GI) bleeding. <b>Methods:</b> A retrospective cohort of 121 adult patients with GC was enrolled from a tertiary Gastroenterology Unit in Western Romania, spanning pre-pandemic (March 2018-February 2020), pandemic (March 2020-February 2022), and post-pandemic (March 2022-February 2024) periods. Demographic profiles, TNM staging, histopathology, <i>H. pylori</i> status, and clinical outcomes-including GI bleeding-were extracted from medical records. <b>Results:</b> An increase in advanced GC (Stage III-IVB) was noted in the post-pandemic period (69.4% vs. 53.3% pre-pandemic; <i>p</i> = 0.021). <i>H. pylori</i> positivity remained higher in NCGC (70.6%) compared to CGC (44.6%; overall <i>p</i> = 0.041); however, CGC cases showed a rise in <i>H. pylori</i> prevalence post-pandemic (36.4% to 55.6%). One-year mortality was driven by an advanced stage (hazard ratio [HR] = 2.74, <i>p</i> = 0.002), diagnosis during the COVID-19 pandemic (HR = 1.66, <i>p</i> = 0.010), and age ≥70 years (HR = 1.88, <i>p</i> = 0.043). <b>Conclusions:</b> Our findings demonstrate that delayed diagnostic endoscopy correlated with a higher proportion of advanced GC in the post-pandemic phase. <i>H. pylori</i> was strongly linked to NCGC, though CGC showed an increasing trend in <i>H. pylori</i> prevalence. Patients on antithrombotic agents faced increased GI bleeding risks.