Clinical, serological and morphological characterization of chronic gastritis in patients with dyspepsia: Data from a prospective urban population analysis

Introduction. Chronic gastritis remains one of the most prevalent disorders of the upper gastrointestinal tract, with H. pylori playing a key role in its pathogenesis.

Aim. To provide a comprehensive clinical, morphological, and serological assessment of the gastric mucosa in patients with chronic gastritis presenting with dyspepsia.

Materials and methods. This prospective single-center study (Moscow, 2021–2025) enrolled 309 patients presenting with dyspepsia. All participants underwent a standardized diagnostic algorithm comprising a 13C-urea breath test (13C-UBT); esophagogastroduodenoscopy (EGD) with multifocal biopsies and OLGA staging; the GastroPanel® serological test (pepsinogen I, pepsinogen II, gastrin-17, and IgG antibodies to H. pylori); and the 7×7 symptom scale.

Results. H. pylori infection was confirmed in 147/309 patients (47.6%). Among H. pylori-positive patients, atrophic chronic gastritis predominated (69.4%), whereas in H. pylori-negative patients superficial (non-atrophic) gastritis was most frequent (91.4%) (p < 0.0001). Within H. pylori-associated atrophic gastritis, early OLGA stages I-II prevailed (86.0%). In the H. pylori-negative subgroup with atrophic gastritis, median PGI was reduced versus superficial gastritis (35.9 vs 78.3 µg/L; p < 0.0001) with moderate changes in PGII and a tendency toward higher G-17. In H. pylori-positive patients, eradication therapy was followed by a significant decrease in total 7×7 scores. ROC analysis of the PGI/PGII ratio for detecting advanced atrophy (OLGA III/IV) yielded an AUC of 0.820 (95% CI, 0.748–0.878), sensitivity 80.0%, and specificity 81.1% at a cut-off ≤ 2. The per-protocol eradication rate was 85.42% (82/96); the safety profile was predominantly mild to moderate (adverse events in 26.0%).

Conclusions. An integrated approach combining OLGA staging, GastroPanel® biomarkers, and the 7×7 scale provides consistent, reproducible stratification of chronic gastritis and optimizes selection for invasive verification. The PGI/PGII ratio shows high diagnostic value for identifying advanced stages of gastric mucosal atrophy (OLGA III/IV), and H. pylori eradication is associated with clinically meaningful symptom improvement.

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