Helicobacter pylori burden and chronic gastritis in women previously treated for breast cancer with persistent dyspepsia: a retrospective comparative endoscopic biopsy study

Persistent dyspepsia in women previously treated for breast cancer is often attributed to treatment toxicity or functional disease, although gastric biopsy findings in this setting are poorly described. We compared gastric histopathology and laboratory profiles in breast cancer survivors and symptomatic women without breast cancer. This single-centre retrospective comparative study included 104 women who underwent upper gastrointestinal endoscopy for persistent dyspeptic symptoms between January 2022 and March 2026: 43 previously treated for invasive ductal breast carcinoma and 61 controls. Biopsy findings were analysed as ordinal 0–3 scores and as binary outcomes. Between-group comparisons used Mann–Whitney U or Fisher's exact tests, with false-discovery-rate correction. Proportional-odds models adjusted for age. Post hoc models of chronic inflammation additionally adjusted for H. pylori positivity or density, and a sensitivity analysis was restricted to H. pylori -positive participants. Age did not differ between groups. Albumin was lower in the breast cancer group after multiplicity adjustment (44.8 [42.0–46.1] versus 47.0 [43.6–50.0] g/L; q=0.020). H. pylori was detected in 60.5% of the breast cancer group and 26.2% of controls (risk difference 34.2%, 95% CI 15.0–50.4; q=0.002), and age-adjusted density scores were higher (adjusted odds ratio [aOR] 7.83, 95% CI 3.33–18.37). Chronic inflammation was present in 100.0% and 75.4%, respectively (risk difference, 24.6%; 95% CI, 12.4–36.7; q=0.002). The age-adjusted association with inflammation was smaller after adjustment for H. pylori density (aOR 2.03, 95% CI 0.82–5.04; p=0.125) and was not statistically significant in H. pylori -positive participants (aOR 2.56, 95% CI 0.75–8.72; p=0.134). No statistically significant differences in atrophy, intestinal metaplasia or dysplasia were detected. Among selected women already referred for endoscopy because of persistent dyspepsia, breast cancer survivors had a higher H. pylori burden than symptomatic controls. The accompanying difference in chronic inflammation was closely related to bacterial density. These associative findings do not support screening of breast cancer survivors generally and require confirmation in prospectively characterised cohorts.