Helicobacter pylori-Mediated Injury: The Hidden Path to Gastric Hemorrhage and Neoplasia

<i>Helicobacter pylori</i> infection represents a well-established risk factor for the development of gastric carcinogenesis, yet reliable clinical or endoscopic predictors of infection remain poorly defined. Identifying non-invasive or endoscopic markers of this infection could improve early detection, which is crucial for effective prevention and clinical management. This single-center study included 737 patients who underwent upper gastrointestinal endoscopy. We compared clinical, laboratory, and endoscopic features between <i>H. pylori</i>-positive and <i>H. pylori</i>-negative individuals. A total of 263 with <i>H. pylori</i>-positive gastric biopsies and 474 with <i>H. pylori</i>-negative biopsies were enrolled in our study. Cerebrovascular disease (9.51% vs. 5.51%, <i>p</i> = 0.04, OR = 1.80), type 2 diabetes mellitus (T2DM-22.05% vs. 15.86%, <i>p</i> = 0.04, OR 1.5), and alcohol consumption (18.96% vs. 9.3%, <i>p</i> = 0.00, OR = 2.28) were significantly more prevalent among <i>H. pylori</i>-positive patients. Heartburn was more commonly reported in <i>H. pylori</i>-negative individuals (23.77% vs. 15.38%, <i>p</i> = 0.01, OR = 0.58). Laboratory parameters showed no significant differences between groups. Regarding endoscopic findings, corporal erythema (26.92% vs. 16.17%, <i>p</i> = 0.00, OR = 1.91), corporal erosions (11.54% vs. 5.32%, <i>p</i> = 0.00, OR = 2.32), and submucosal hemorrhages (20.91% vs. 11.6%, <i>p</i> = 0.00, OR = 2.01) were associated with <i>H. pylori</i> infection. In the multivariate logistic regression models, alcohol consumption and corporal lesions remained independent predictors of <i>H. pylori</i>-associated gastritis, even after adjusting for age, sex, and PPI use. This study identifies alcohol consumption and specific corporal mucosal changes as novel, independent predictors of <i>H. pylori</i> infection. Heartburn was negatively associated with active <i>H. pylori</i> infection, while the rest of the symptoms did not predict infection or mucosal lesions. The laboratory parameters did not differ significantly between groups. These findings underscore the potential of targeted endoscopic evaluation and risk-based screening (particularly among T2DM and alcohol-consuming populations) to enhance early detection and management of <i>H. pylori</i>-associated disease.