Fecal miR-146a as a Non-Invasive Biomarker for Helicobacter pylori-Associated Gastritis

Background: Helicobacter pylori remains a major cause of chronic active gastritis and a clinically relevant precursor of peptic ulcer disease and gastric neoplasia. Host-derived non-invasive biomarkers that reflect infection-related gastric inflammation are still insufficiently developed. This study evaluated the clinical relevance of fecal miR-146a in patients with H. pylori-associated gastritis. Methods: We conducted a prospective study over a 3-year period (2023–2025) at the County Clinical Emergency Hospital Sibiu, Romania. The study included 85 adults: 45 patients with confirmed H. pylori-associated gastritis and 40 controls. Demographic, clinical, inflammatory, endoscopic, histopathological, and molecular data were analyzed. Continuous variables were compared using the Mann–Whitney U test and categorical variables using the chi-square or Fisher’s exact test. Multivariable analysis was performed using Firth’s penalized logistic regression. Results: Patients with H. pylori-associated gastritis showed significantly higher fecal miR-146a expression than controls (2.05 [1.77–2.37] vs. 0.88 [0.77–0.99], p < 0.001). They also had higher CRP, ESR, WBC, abdominal pain scores, and a greater burden of endoscopic and histopathological abnormalities. In both multivariable models, fecal miR-146a remained the only significant variable associated with disease status. Conclusions: Fecal miR-146a is markedly elevated in H. pylori-associated gastritis and may represent a promising non-invasive biomarker of infection-related gastric inflammation. Larger prospective studies are needed for validation.