The OLGA (Operative Link for Gastritis Assessment) and OLGIM (Operative Link on Gastric Intestinal Metaplasia) staging systems stratify gastric cancer risk based on the severity and topography of atrophy and intestinal metaplasia. Endoscopic patterns such as nodularity, mosaic mucosa, erosions, or ulcer disease may correlate with underlying histological severity. This study evaluated the association between endoscopic findings and OLGA/OLGIM histological stages in patients with Helicobacter pylori (H. pylori) infection in Kairouan, Tunisia.

We conducted a retrospective study including 89 adults with histologically confirmed H. pylori infection who underwent upper gastrointestinal endoscopy between January and August 2024. Endoscopic findings (erythema, nodularity, mosaic pattern, erosions, ulcer disease) were collected. Histopathology assessed chronic inflammation, activity, glandular atrophy, intestinal metaplasia, and H. pylori density according to the Sydney system, allowing indirect categorization into OLGA and OLGIM stages. Associations between endoscopic abnormalities and histological severity markers were analyzed descriptively.

Erythematous gastritis was the most common endoscopic finding (92.1%), followed by nodularity (21.3%), mosaic pattern (15.7%), erosions (16.9%), and ulcer disease (8.9%). Histology showed chronic gastritis in 98.9%, mild-to-severe inflammatory activity in 91%, glandular atrophy in 13.5%, and intestinal metaplasia in 6.7%. Nodularity and mosaic patterns were predominantly associated with higher H. pylori density and active inflammation—corresponding to early OLGA stages (I–II). Erosions and ulcer disease were more frequently associated with moderate activity and early atrophy, suggesting progression toward intermediate OLGA stage II. Patients with glandular atrophy or intestinal metaplasia (compatible with OLGA/OLGIM II–III) more often exhibited mucosal pallor, loss of folds, or mosaic patterns rather than nodularity. No high-risk OLGA/OLGIM stage IV lesions were identified.

Endoscopic findings correlate with key histological components of the OLGA/OLGIM systems. Nodularity reflects high bacterial load and early-stage gastritis, while mosaic patterns, erosions, and mucosal thinning are more frequently associated with atrophy or intestinal metaplasia. Integrating endoscopic patterns with OLGA/OLGIM staging may enhance early risk stratification for gastric cancer in H. pylori–infected patients, particularly in resource-limited settings.