Helicobacter pylori Colonization and Intestinal Metaplasia Risk in an Andean Population: A Cross-Sectional Study from Peru

Background: Helicobacter pylori infection is recognized as a Group I carcinogen and a primary driver of the gastric precancerous cascade. Andean populations in Peru experience disproportionately high rates of gastric cancer, yet data characterizing the association between H. pylori colonization and intestinal metaplasia remain limited in this setting. Methods: A cross-sectional analytical study was conducted among 169 patients undergoing upper gastrointestinal endoscopy at Hospital II EsSalud Abancay, Apurímac, Peru, between January and August 2025. Histopathological assessment determined H. pylori status, colonization intensity (negative, +, ++, +++) and intestinal metaplasia presence using the Updated Sydney System. Binary logistic regression estimated adjusted odds ratios (aORs) with 95% confidence intervals. Results: H. pylori infection was detected in 71 patients (42.0%), and intestinal metaplasia was present in 78 (46.2%). A dose–response pattern was observed: metaplasia prevalence increased from 18.4% in uninfected patients to 70.0%, 87.0%, and 92.9% across increasing colonization intensities (Cochran–Armitage p < 0.001). In multivariable analysis, colonization intensity (aOR = 10.19; 95% CI: 4.38–23.71), smoking (aOR = 11.70; 95% CI: 1.98–69.03), and alcohol consumption (aOR = 6.32; 95% CI: 1.74–22.95) remained independently associated with metaplasia. The primary binary logistic regression model demonstrated excellent discrimination (AUC = 0.921). Conclusions: H. pylori colonization intensity is strongly associated with intestinal metaplasia in this Andean population, with a clear dose–response gradient. These findings support prioritizing H. pylori screening and eradication strategies for gastric cancer prevention in highland Peru.