Resistance-associated gene mutations in Helicobacter pylori and the correlation with serological antibody typing among patients in Shenyang, China

The increasing antibiotic resistance of Helicobacter pylori ( H. pylori ) has become a major challenge for successful eradication therapy. This retrospective cross-sectional study aimed to characterize the distribution of resistance-associated gene mutations in H. pylori -infected patients in Shenyang, China, and to evaluate their association with serological antibody typing. A retrospective analysis was conducted on 984 patients who visited the Department of Gastroenterology and Endoscopy at the Fifth People’s Hospital of Shenyang between January 2023 and September 2025 and underwent resistance-associated genes testing in H. pylori . Mutations in genes associated with resistance to commonly used antibiotics were analyzed. In addition, 274 patients who tested positive for the 13 C‑urea breath test ( 13 C-UBT) during the same period and 66 patients who received serological H. pylori antibody testing were included. Further genetic characterization of H. pylori was performed using gastric mucosal biopsy specimens from these patients. Among 984 participants, clarithromycin and quinolones resistance-associated gene mutations were the most frequently detected, with clarithromycin and quinolones being the most common co-occurring resistance-associated gene mutation pattern. Among 274 patients with positive 13 C-UBT results, 239 tested positive by gastric mucosal H. pylori genetic testing, indicating partial discordance between the two diagnostic approaches. In contrast, agreement analysis showed that Type I serological antibody status was associated with H. pylori genetic testing results (Cohen’s kappa coefficient (κ) = 0.768, p < 0.001). Meanwhile, resistance-associated gene mutations were frequently detected among serological antibody-positive patients, particularly for Type I antibody ( p < 0.001). In Shenyang, China, H. pylori resistance-associated gene mutations were mainly related to clarithromycin and quinolones. Partial discordance was observed between ¹³C-UBT and gastric mucosal H. pylori genetic testing. In the serological subgroup, resistance-associated gene mutations were frequently detected among Type I antibody-positive patients, suggesting a possible co-occurrence between Type I antibody-positive status and resistance-associated gene mutations. These findings suggest that serological antibody typing may provide additional information on H. pylori molecular characteristics when interpreted together with ¹³C-UBT results. However, its clinical utility requires further validation in larger studies.