Aims
We evaluated the relationship between Helicobacter pylori (HP) gastritis, Gastroesophageal reflux disease (GERD), and serum vitamin B12 levels in patients undergoing upper gastrointestinal endoscopy for dyspeptic symptoms, since the available literature is conflicting. We also looked at the cross-country variations in this regard between Türkiye and India.
Methods
This multicenter, retrospective study included patients who underwent endoscopy between December 2024 – November 2025 for dyspeptic symptoms. Demographic, laboratory, and endoscopic findings were collected. HP infection was diagnosed by gastric biopsy or rapid urease test. Data from tertiary centers, one from Türkiye and one from India were used. Categorical variables were compared using the Chi-square or Fisher’s exact test, and continuous variables using the independent t-test or Mann–Whitney U test.
Results
1. Baseline Characteristics: Among 500 patients, 275 (55%) were male, with a mean age of 47.5 ± 14 years. Gender distribution was similar between countries (p = 0.141).
2. Prevalence of HP Gastritis and Gastric Involvement: HP gastritis was detected in 336 (67.2%) patients, slightly higher than previously reported [1]. HP prevalence was significantly greater in India (76% vs. 62.1%; p = 0.001). Intestinal metaplasia was present in 16.7% of the 300 biopsied patients. Pattern of gastric involvement; antral in 404 (80.8%), antral-predominant in 34 (6.8%), corpus involvement was in 62 (12.4%) patients. HP gastritis was more frequent in men (p = 0.004) and in individuals < 60 years (p = 0.011).
3. Endoscopic Findings: Endoscopic hyperemia, erosions, atrophy, ulcers, nodularity, and duodenitis were all significantly associated with HP infection (all p < 0.05). Hiatal Hernia (HH) was seen in 37 (7.4%) patients. HH was more frequent in Indian patients (p < 0.001).
4. GERD: GERD was diagnosed in 166 (33.2%), and was less common in HP-positive individuals (29.5% vs. 40.9%; OR 0.605, 95% CI 0.401–0.893; p = 0.011) similar to a recent study [2]. GERD was more frequent in patients with corpus involvement (p = 0.007). GERD was more common in Türkiye (39.8% vs. 11.5%; p < 0.001).
5. Vitamin B12 Levels and Deficiency: Mean vitamin B12 levels were significantly lower in HP-positive patients (334 ± 193 vs. 418 ± 198 ng/L; p < 0.001). Vitamin B12 deficiency was more frequent in HP-positive patients (30.4% vs. 9.4%; p < 0.001), consistent with prior reports [3–5]. Serum B12 deficiency was markedly higher in India (41.5% vs. 5.2%; p < 0.001). Hemoglobin levels were similar across all groups. Serum B12 levels were lower in HP-positive Turkish patients, but the deficiency was lesser than in Indian patients.
Factors associated with B12 deficiency: More common with corpus involvement (p = 0.023)
The key findings of the study have been summarised in the Table.
|
Parameter |
HP (+) |
HP (-) |
p-value |
Türkiye |
India |
p-value |
|
|
HP prevalence, % |
67.2 |
32.8 |
|
62.1 |
76 |
0.001 |
|
|
GERD, n (%) |
99(29.5) |
67(40.9) |
0.011 |
104(39.8) |
23(11.5) |
< 0.001 |
|
|
Corpus, n (%) |
47(14) |
15(9.1) |
0.123 |
36(13.8) |
21(10.5) |
0.287 |
|
|
Antral predominant, n (%) |
30(8.9) |
4(2.4) |
0.007 |
4(1.5) |
29(14.5) |
< 0.001 |
|
|
Antrum, n (%) |
259(77.1) |
145(88.4) |
0.003 |
221(84.7) |
150(75) |
0.009 |
|
|
Ulcers, n (%) |
38(11.3) |
9(5.5) |
0.036 |
24(9.2) |
22(11) |
0.522 |
|
|
B12 deficiency, n (%) (404/372) |
84(30.4) |
12(9.4) |
< 0.001 |
9(5.2) |
83(41.5) |
< 0.001 |
Conclusions
In this cross-country study, Helicobacter pylori infection was highly prevalent in dyspeptic patients and consistently associated with endoscopic abnormalities. Although GERD was common overall, it was less frequent in HP-positive patients, suggesting a protective effect in both groups studied. HP-positive patients have lower vitamin B12 levels, particularly with corpus-predominant gastritis. These findings highlight the need to consider both nutritional impact and reflux patterns when managing HP gastritis across different populations.