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Multicenter Study
. 2025 May 27;25(1):766.
doi: 10.1186/s12879-025-11147-3.

Epidemiology of Helicobacter pylori, gastric precancerous lesions and gastric cancer: a multicenter, population-based cross-sectional study in Nanjing

Chunyan Niu #  1 , Yongqiang Song #  2 , Yue Chen  2 , Yongqiang Shi  2 , Hui Wang  2 , Xinguo Wu  2 , Xiaoping Wang  2 , Xiangyang Zhao  2 , Yongdan Bu  3 , Jijin Li  4 , Tao Tao  5 , Jinhua Wu  6 , Changlin Xue  7 , Fuyu Zhang  8 , Chunrong Han  9 , Juan Yuan  9 , Qiang Zhang  10
Affiliations
Multicenter Study

Epidemiology of Helicobacter pylori, gastric precancerous lesions and gastric cancer: a multicenter, population-based cross-sectional study in Nanjing

Chunyan Niu et al. BMC Infect Dis. .

Abstract

Background: Nanjing City has a high-incidence gastric cancer (GC), but the epidemiology of gastric precancerous lesions (GPLs) remains poorly understood. This study aimed to investigate the epidemiological characteristics of Helicobacter pylori (H. pylori) infection, GPLs, and GCs in patients undergoing endoscopic examination in Lishui District, Nanjing.

Methods: This retrospective, population-based, cross-sectional study was conducted collaboratively by the Nanjing Lishui People's Hospital and six medical community units within the county between July 2022 and June 2023. Data on biopsies and 13C urea breath tests (13C-UBT) were collected.

Results: A total of 15,668 individuals were included, among whom 259 had GPL (1.65%) and 218 had GC (1.39%). The H. pylori infection rate in total patients was 5014 (32.00%) (males: 2684 (34.06%); females: 2335 (29.92%)). The H. pylori infection rate is 31.45% in benign gastric lesions, 44.40% in GPLs, and 55.50% in GC, respectively. The multivariable logistic regression analysis showed that male (OR = 3.156, 95% CI: 2.865-3.376, P < 0.001), age (OR = 1.785, 95% CI: 1.703-1.876, P < 0.001), fresh vegetable, fruit, and white meat intake frequently (OR = 0.865, 95% CI: 0.506-2.061, P = 0.029), high-salt diet and high-fat diet intake frequently (OR = 1.906, 95% CI: 1.101-2.932, P = 0.014), rural residence (OR = 2.682, 95% CI: 1.010-4.754, P = 0.040), H. pylori infection (OR = 2.022, 95% CI: 1.155-2.865, P < 0.001) and atrophic gastritis and/or intestinal metaplasia (OR = 4.875, 95% CI: 2.229-10.663, P < 0.001) were associated with GPLs. Male (OR = 2.021, 95% CI: 1.080-3.780, P = 2.028), age (OR = 1.201, 95% CI: 1.174-1.238, P < 0.001), digestive symptoms (OR = 2.256, 95% CI: 1.548-3.289, P < 0.001), bachelor degree below (OR = 4.792, 95% CI: 3.439-6.837, P < 0.001), farmer (OR = 1.039, 95% CI: 1.026-1.159, P < 0.001), fresh vegetable, fruit, and white meat intake (OR = 0.231, 95% CI: 0.141-0.379, P < 0.001), fried/barbecue/pickled food intake (OR = 6.781, 95% CI: 3.783-12.153, P < 0.001), high-salt diet and high-fat diet intake (OR = 4.374, 95% CI: 2.363-8.097, P < 0.001), rural residence (OR = 1.230, 95% CI: 1.121-1.437, P < 0.001), H. pylori infection (OR = 3.248, 95% CI: 2.357-4.477, P < 0.001) and atrophic gastritis and/or intestinal metaplasia (OR = 4.875, 95% CI: 2.636-9.016, P < 0.001) were associated with GCs.

Conclusions: These findings underscore the importance of implementing targeted prevention strategies and early detection programs in high-risk populations to mitigate the burden of GPLs and GCs in Nanjing.

Keywords: Helicobacter pylori infection; Gastric cancer; Gastric precancerous lesions; Gastroscopy examination; Retrospective cross-sectional study; Screening.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was approved by the Medical Ethics Committee of Nanjing Lishui People’s Hospital (as the lead center) (approval #2023 KY0727-02) and by the Ethics Committee at each participating center. The requirement for individual informed consent was waived by the committees because of the retrospective nature of the study. This study was conducted in accordance with the Declaration of Helsinki. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Study flowchart
Fig. 2
Fig. 2
Detection rate and age trends of gastric precancerous lesions (GPLs) and gastric cancer (GC) in different sexes. The red and brown columns represent the number of cases of GPLs and GC in males, while the blue and green columns represent the number of cases of GPL and GC in females, respectively. Dashed lines of the same color as the columns represent the detection rates of GPL and GC for males and females, respectively. The X-axis represents the age ranges, while the left Y-axis represents the specific number of detected cases. The right Y-axis represents the specific detection rate
Fig. 3
Fig. 3
Detection rate and age trend of different pathological types. The red, blue, brown, and green columns represent the number of detected cases of low-grade intraepithelial neoplasia (LGIN), high-grade intraepithelial neoplasia (HGIN), early gastric cancer (EGC), and advanced gastric cancer (AGC), respectively. The line with the same color as the column represents the detection rate of the corresponding pathological type. The X-axis represents the age ranges, while the left Y-axis represents the specific number of detected cases. The right Y-axis represents the specific detection rate
Fig. 4
Fig. 4
Age trend of Helicobacter pylori infection rate. The red, blue, and purple lines represent the H. pylori infection rate in benign lesions, gastric precancerous lesions (GPLs), and gastric cancer (GC), respectively. The X-axis represents the age groups, while the Y-axis represents the specific values of H. pylori infection rate
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