Background
While the Updated Sydney System classifies Helicobacter pylori density together with inflammatory scores, the clinical relevance of bacterial load remains uncertain. This study aimed to assess the association between histological H. pylori density and the severity of gastric inflammatory activity.
Methods
We performed a retrospective analysis of 1680 treatment-naive patients from a Chinese cohort (2022-2023). H. pylori density was categorized as low or high grades, with marked neutrophilic infiltration as the primary outcome. Multivariable logistic regression adjusted for potential confounders.
Results
Among 2298 biopsy sites from 1680 patients (median age 52 years; 48.2% female), high H. pylori density showed no significant overall association with marked inflammation (all p > 0.050). While a significant inverse association was observed in non-atrophic antral single-site biopsies (adjusted odds ratio 0.52; 95% confidence interval 0.28-0.93), it was not reproduced in multi-site analyses. Increasing age was associated with a lower prevalence of severe antral inflammation.
Conclusions
Histological H. pylori density might therefore not be a reliable marker of neutrophilic activity, although a significant inverse association observed in a single-site subgroup was not reproducible and may reflect sampling variability.
Trial registration
N/A.