Prevalence and Endoscopic Documentation of Helicobacter pylori and Gastric Precancerous Conditions in Routine Gastroscopy with Biopsies: A Cross-Sectional Study

Abstract In Western countries without screening programs, Helicobacter pylori infection, gastric atrophy, and intestinal metaplasia must be detected opportunistically during endoscopy, yet real-world data on how reliably this occurs are scarce. We determined their histologic prevalence among biopsied diagnostic gastroscopies and how completely they are recorded in routine endoscopy reports. Retrospective single-center cross-sectional study of all diagnostic gastroscopies with gastric biopsies at a tertiary university hospital (2016–2025). Documentation of each lesion was compared with institutional histopathology reports. As only biopsied examinations were eligible, concordance measures reporting completeness. Prevalence was analyzed at patient level (n = 9,852) and concordance at examination level (n = 11,381). H. pylori infection or any gastric precancerous condition was present in 31.4% of patients (H. pylori 11.5%, atrophy 6.6%, intestinal metaplasia 21.5%). A corresponding finding was recorded in the endoscopy report in 9.6% (95% CI 8.0–11.4) of H. pylori-positive, 9.2% (8.1–10.3) of metaplasia-positive and 49.4% (45.8–52.9) of atrophy-positive examinations. Counting rapid urease tests, which indicate H. pylori testing but not written mucosal suspicion, increased documentation to 46.0%. Results were similar with antrum-and-corpus sampling (90.7%; ≤0.7 percentage points). The publication of MAPS-II or newer endoscopy generations did not increase documentation substantially. H. pylori infection and gastric precancerous conditions affected nearly one-third of biopsied patients, yet most histologically confirmed findings were not explicitly documented at endoscopy. Closing this documentation gap should be a priority for integrating gastric cancer risk assessment into routine endoscopic reporting.