A population-based study of Helicobacter pylori: Does asymptomatic infection mean no gastroscopic lesions?

Objectives: We determined the common clinical characteristics of patients infected with Helicobacter pylori (H. pylori) and investigated the relationship between H. pylori infection, and clinical symptoms, and gastroscopic manifestations. Our focus was specifically on the clinical manifestations in asymptomatic patients.Methods: We obtained the physical examination data of patients who underwent the C-14 urea breath test between January 2018 and December 2020 at our Hospital. Basic demographic data, questionnaire data on clinical symptoms, and clinical examination data of the patients were also collected, and the correlation analysis was performed.Results: A total of 2863 participants were included in the study. The overall H. pylori infection rate was 26.30%. The clinical symptoms between H. pylori-positive patients and H. pylori-negative patients did not differ significantly (P > .05). However, H. pylori-positive patients exhibited more severe gastroscopic manifestations (P < .001). The C-14 urea breath test disintegrations per minute (DPM) values in H. pylori-positive patients correlated with their serum pepsinogen and gastrin-17 levels. With an increase in the DPM value, more combinations of clinical symptoms appeared in the patients. Among H. pylori-positive patients, DPM levels in asymptomatic patients were lower than those in symptomatic patients (P < .001). However, gastroscopic manifestations did not vary significantly between asymptomatic and symptomatic patients (P > .05).Conclusion: Patients infected with H. pylori showed no specific gastrointestinal symptoms. Patients with asymptomatic infection showed lower DPM levels, but their gastroscopic manifestations were similar to those of patients with symptomatic infection, and their lesions were more severe than H. pylori-negative people.Key messageWhat is already known on the subject center dot H. pylori is highly contagious and is an important etiological factor for many kinds of disease.center dot Eradication of H. pylori infection can decrease the cost of prevention, diagnosis, and treatment of H. pylori-associated diseases, but the eradication therapy may lead to adverse drug reactions.center dot It has been suggested the treatment for asymptomatic infections should not overkill.What we have found center dot Gastroscopic manifestations of asymptomatic patients were similar to those of symptomatic patients. Both of their lesions were more severe than H. pylori-negative individuals.center dot We provide a theoretical basis for the consideration of the need for further gastroscopy and treatment in clinically asymptomatic infected patients.