Helicobacter pylori (H. pylori) infection plays a pivotal role in the development of gastric precancerous lesions. Gastric atrophy and intestinal metaplasia (IM) constitute key stages in Correa’s cascade leading to gastric adenocarcinoma. This study aimed to determine the prevalence of these lesions and to identify factors associated with their occurrence among patients with histologically confirmed H. pylori infection.

We conducted a retrospective descriptive and analytical study in the Department of Hepato-Gastroenterology at Sahloul University Hospital (2020–2024). All patients with H. pylori infection confirmed by histology according to the Sydney System were included. Demographic and histologic data were collected. Associated factors were analyzed using Chi-square and Student’s t-tests, followed by multivariate logistic regression.

A total of 339 patients were included (mean age 48.5 ± 16.7 years; sex ratio M/F = 1.2). More than half (56%) were older than 45 years, and smoking was reported in 14%. Gastric atrophy was present in 68% of patients, predominantly in the antrum (72%), followed by the fundus (20%) and pangastric involvement (8%). Atrophy was significantly associated with higher gastritis activity (p = 0.001) and age > 50 years (p = 0.03).Intestinal metaplasia was identified in 13% of cases. In multivariate analysis, independent predictors of IM were age > 50 years (OR 1.3; 95%CI 1.1–1.6; p = 0.01) and severe atrophy (OR 2.2; 95%CI 1.1–4.5; p = 0.03).

Among patients infected with H. pylori, gastric atrophy and intestinal metaplasia are frequent and strongly interrelated precancerous lesions. The severity of atrophy emerges as a key predictor of IM, emphasizing the need for early H. pylori eradication and tailored endoscopic surveillance strategies.