High prevalence and endoscopic patterns of Helicobacter pylori Infection among symptomatic adults in Douala, Cameroon: sociodemographic and behavioral correlates

Abstract Background Helicobacter pylori infection remains a major cause of chronic gastritis, peptic ulcer disease, and gastric cancer, particularly in low- and middle-income countries. This study investigated the prevalence, diagnostic performance of commonly used tests, endoscopic patterns, and factors associated with H. pylori infection among symptomatic adults undergoing upper gastrointestinal endoscopy in Douala, Cameroon. Methods A cross-sectional study was conducted among 842 consecutive symptomatic adults referred for upper gastrointestinal endoscopy at two tertiary hospitals in Douala. Sociodemographic, behavioral, clinical, and endoscopic data were collected using a standardized questionnaire. Histopathological examination (H&E staining) served as the gold standard for diagnosing H. pylori infection. ELISA and rapid urease testing were also performed. Logistic regression was used to identify factors independently associated with infection. Results Histology detected H. pylori infection in 616 participants, corresponding to a prevalence of 73.2%. Epigastric pain was the most common indication for endoscopy (59.9%), while erosive lesions or ulcerations (28.4%) and inflammatory lesions (22.3%) were the predominant endoscopic findings. ELISA demonstrated excellent diagnostic performance, with a sensitivity of 99.7%, specificity of 100.0%, diagnostic accuracy of 99.8%, and almost perfect agreement with histology (κ = 0.994). The rapid urease test showed a sensitivity of 88.3%, specificity of 88.5%, diagnostic accuracy of 88.4%, and substantial agreement (κ = 0.722). Independent predictors of infection included younger age (15–32 years; aOR = 2.88), living in households with five members (aOR = 9.83), blood group O (aOR = 2.25), vomiting (aOR = 12.60), investigation for anemia (aOR = 16.38), and absence of medication use (aOR = 4.33). Infection was most frequent in patients with gastric tumors (100%), active duodenal ulcers (91.2%), and active gastric ulcers (82.1%). Conclusions Helicobacter pylori infection remains highly prevalent among symptomatic adults in Douala. ELISA showed excellent agreement with histology, while the rapid urease test provided good diagnostic accuracy. The strong associations with specific demographic, clinical, and endoscopic characteristics support targeted screening and early management of high-risk patients in Cameroon.