Changes of Helicobacter pylori Infection Status and Risk of Precancerous Lesions: A Prospective Cohort Study in Chinese Population

OBJECTIVE: To evaluate the associations of both baseline serological profiles and serological transitions of Helicobacter pylori infection patterns with the risk of precancerous gastric lesions (PGLs). DESIGN: We analyzed data from 6208 participants in the FuSion cohort who underwent gastroscopy examination, with available H. pylori antibody and pepsinogen measurements at both baseline and follow-up. H. pylori status defined by IgG antibodies (Ab) and pepsinogens (PG), classified participants into four ABC groups. Multivariable logistic regression evaluated associations with PGLs across baseline and transition statuses. Trend tests were performed across the ABC groups and infection transition categories. RESULTS: A significant increasing trend in the PGLs prevalence and severity was observed across the ABC groups (p for trend < 0.05). Analysis of infection transitions revealed graded risk increases for PGLs from consistently negative to remained positive groups. Interestingly, even participants who seroreverted remained at significantly elevated risks of atrophic gastritis (adjusted odds ratio [aOR] = 2.01, 95% CI: 1.67-2.43) and intestinal metaplasia (aOR = 1.72, 95% CI: 1.14-2.51) compared to the persistently negative participants. The sensitivity analyses excluding baseline PG-positive subjects yielded similar results. CONCLUSION: Long-term exposure to H. pylori is associated with an increased risk of PGLs, and this risk may remain elevated even after seroreversion.