Histological Footprint of Helicobacter Pylori: Insights from the Updated Sydney Grading System

Abstract

Background: Helicobacter pylori is a common chronic bacterial infection associated with chronic gastritis, peptic ulcer disease, gastric adenocarcinoma, and mucosa-associated lymphoid tissue lymphoma. Histopathological examination of gastroduodenal biopsies remains the gold standard for its detection and assessment of mucosal changes.

Aim: To determine the prevalence of H. pylori in gastroduodenal biopsies, evaluate associated histopathological changes using the Updated Sydney Classification, and correlate bacterial density with histological findings.

Materials and Methods: This prospective observational study included 122 gastroduodenal biopsy specimens collected over two years. Sections were stained with Hematoxylin and Eosin and modified Giemsa stain. Histopathological parameters were graded according to the Updated Sydney Classification.

Results: H. pylori was detected in 68 (55.7%) cases, with higher prevalence in gastric (58.4%) than duodenal (48.5%) biopsies. Chronic gastritis was the most frequent lesion. Moderate bacterial density was the commonest finding (41.9%), followed by severe (35.5%) and mild (22.6%) density. Active chronic gastritis was present in 51.6% of cases, and H. pylori density showed a significant association with neutrophilic activity (p=0.0094).

Conclusion: H. pylori infection was strongly associated with chronic gastritis and active inflammation. Routine histopathological evaluation using H&E, modified Giemsa staining, and the Updated Sydney Classification provides reliable detection and standardized grading, supporting its routine use in gastric biopsy reporting to guide clinical management and improve patient outcomes.