Helicobacter Pylori, Intestinal Metaplasia, and Diagnostic Timeliness in Secondary-Care Upper Gastrointestinal Endoscopy: A Retrospective Study

Objective: This study evaluated clinical, endoscopic, and histopathological findings, Helicobacter pylori positivity, gastric intestinal metaplasia, and diagnostic timeliness in a secondary-care upper gastrointestinal endoscopy unit.Methods: This single-centre retrospective study included 255 gastroscopy procedures performed between January 2023 and December 2024, representing 251 unique patients; biopsy was obtained in 246 procedures. Histopathological prevalence estimates were reported at the procedure level. For inferential analyses, only the first eligible gastroscopy per patient was included, yielding 242 biopsied patients. The primary outcome was intestinal metaplasia. Group comparisons used Mann–Whitney U, chi-square, or Fisher’s exact tests, and multivariable logistic regression was performed.Results: H. pylori positivity was detected in 128/246 biopsies (52.0%; 95% CI, 45.8–58.2%), and intestinal metaplasia in 70/246 (28.5%; 95% CI, 23.2–34.4%). Neutrophil activity and atrophy were present in 58.5% and 12.2%, respectively; non-invasive dysplasia was identified in one case (0.4%) and adenocarcinoma in two (0.8%). Neutrophil activity was present in 83.5% of H. pylori-positive and 32.2% of H. pylori-negative patients and was interpreted descriptively. In multivariable analysis, age was not significantly associated with intestinal metaplasia (aOR, 1.23 per 10-year increase; 95% CI, 0.98–1.54; p=0.070), whereas pangastritis was associated with intestinal metaplasia (aOR, 2.57; 95% CI, 1.19–5.51; p=0.016). Median appointment waiting time was 7 days and pathology turnaround time was 20 days. Waiting time did not differ by alarm-feature status [7 (3–10) vs 7 (3–13) days; p=0.905].Conclusion: H. pylori positivity and intestinal metaplasia were common in this secondary-care cohort. The H. pylori–neutrophil activity relationship should be interpreted descriptively, and the association between pangastritis and intestinal metaplasia as exploratory. Standardised biopsy protocols and monitoring of diagnostic timeliness remain important in secondary-care endoscopy practice.