Background:

Helicobacter pylori (H. pylori) triggers a strong inflammatory response in the gastric mucosa, initiating a sequence of histopathological changes known as the Correa cascade-ranging from chronic gastritis to atrophy, gastric intestinal metaplasia (GIM), dysplasia, and ultimately gastric cancer (GC). As the earliest phenotypic marker in this carcinogenic pathway, the early detection of GIM in H. pylori-infected patients is critical for effective risk stratification and prevention of GC.

Objective:

To determine the prevalence of complete (CGIM) and incomplete (IGIM) GIM in H. pylori-positive patients using image-enhanced endoscopy (IEE) and Blue Laser Imaging (BLI), a form of electronic chromoendoscopy.

Materials and Methods:

Upper gastrointestinal endoscopy was performed in 750 consecutive patients. Histology confirmed H. pylori infection in 219 cases (38.8%). In this cohort, GIM was assessed endoscopically with IEE/BLI, and targeted biopsies were obtained for histological confirmation.

Results:

Endoscopic evaluation identified GIM in 60 of the 219 H. pylori- positive patients (27.4%): 49 (82%) CGIM and 11 (18%) IGIM. Histology confirmed CGIM in 46 patients (77%) and IGIM in 11 patients (18%). Compared with histology, IEE/BLI achieved a sensitivity of 100 % and a specificity of 97 % for detecting any GIM.

Conclusion:

Image-enhanced endoscopy combined with Blue Laser Imaging is a highly accurate, real- time technique for detecting and subtyping gastric intestinal metaplasia in H. pylori-infected patients, supporting its routine use in endoscopic surveillance and gastric-cancer risk assessment.