Beyond Helicobacter pylori: Prevalence, Coinfection, and Clinicopathologic Patterns of Non-Helicobacter pylori Helicobacter (NHPH) in Human Gastric Biopsies.

BACKGROUND

Non-Helicobacter pylori Helicobacter (NHPH) species are increasingly recognized as human gastric colonizers, yet their prevalence, species distribution, and clinical significance remain incompletely defined, particularly in patient cohorts in the Middle East.

MATERIALS AND

METHODS

In this retrospective study, 830 formalin-fixed paraffin-embedded gastric biopsy samples collected from patients undergoing esophagogastroduodenoscopy at Tzafon Medical Center, northern Israel, between 2022 and 2024 were subjected to species-specific PCR for H. pylori and NHPH species. Clinical, demographic, histopathological, and endoscopic data were correlated with PCR-defined infection status.

RESULTS

H. pylori was detected in 643/830 (77.5%), whereas at least one NHPH species was detected in 179 samples (21.6%). H. bizzozeronii was the predominant NHPH species, identified in 167/830 samples (20.1%), while H. heilmannii, H. felis, and H. ailurogastricus were rare (< 1%), and H. suis and H. salomonis were not detected. Co-infection with H. pylori was common (18.2%), and was detected in 23.5% of all H. pylori-positive samples and 84.4% of NHPH-positive samples. NHPH prevalence was higher in females and demonstrated marked seasonality, peaking in autumn. Histopathological comparison showed a significant difference in foveolar hyperplasia rates across infection groups, with higher frequencies in NHPH-only and PCR detected negative for all species samples than in H. pylori-positive groups. In contrast, clinical symptoms and endoscopic findings were broadly comparable across infection strata.

CONCLUSIONS

These findings provide the first large-scale molecular characterization of gastric NHPH in Israel and show that NHPH, predominantly H. bizzozeronii, is relatively common in this population, is usually co-detected with H. pylori, and is associated more strongly with distinct epidemiologic and histopathologic patterns than with a distinct clinical or endoscopic phenotype.