Correlation analysis between Helicobacter pylori antibody typing and endoscopic classification of chronic atrophic gastritis and OLGA/OLGIM staging

Background and aim : Chronic atrophic gastritis (CAG) is a well-established precancerous condition in the gastric carcinogenesis cascade. Helicobacter pylori (Hp) infection is the primary etiological factor for CAG; however, the differential impact of Hp virulence types on endoscopic and histopathological severity remains incompletely characterized. This study aimed to investigate the correlation between Hp antibody typing and endoscopic classification of CAG based on the Kimura-Takemoto system, as well as OLGA and OLGIM staging. Methods : We conducted a retrospective analysis of 742 patients diagnosed with CAG at the Department of Gastroenterology, Yunnan University Affiliated Hospital, between January 2023 and December 2025. Clinical data, including magnifying endoscopy findings, histopathological results, Hp infection status, and antibody typing, were systematically collected and analyzed. The relationships between Hp antibody types and Kimura-Takemoto endoscopic classification, OLGA staging, and OLGIM staging were evaluated using chi-square tests and Fisher's exact tests. Results : Among the 742 patients with CAG, 601 (81.0%) tested positive for Hp infection, including 226 (37.6%) with type I Hp infection and 375 (62.4%) with type II Hp infection. Patients with Hp infection exhibited significantly more severe endoscopic atrophy compared to Hp-negative patients (P = 0.013). No significant difference in endoscopic atrophy severity was observed between type I and type II Hp infection (P = 0.087). However, patients with type I Hp infection demonstrated significantly higher OLGA stages (P < 0.001) and OLGIM stages (P < 0.001) compared to those with type II Hp infection. Among type I-infected patients, 44.2% had OLGA stage III–IV and 43.8% had OLGIM stage III–IV, compared to 16.3% and 8.5%, respectively, in type II-infected patients. Conclusions : Hp infection exacerbates the extent of endoscopic atrophy in patients with CAG, while type I Hp infection is associated with more severe histopathological atrophy and intestinal metaplasia. The combination of endoscopic CAG classification, histopathological staging, and Hp antibody typing may serve as an effective strategy for precision diagnosis and risk stratification in patients with CAG.