[Comparison of clinicopathological features of early gastric cancer and precancerous lesions in different chronic gastritis settings].

Objective: While chronic gastritis caused by Helicobacter pylori (H.pylori)infection is a well-established driver of gastric carcinogenesis, research interest has increasingly focused on the association between autoimmune gastritis (AIG) and gastric cancer. The aim of this study was to compare the endoscopic and pathological features of early gastric cancer (EGC) and precancerous lesions between H. pylori-related gastritis and AIG. Methods: Patients with EGC and precancerous lesions who attended the Department of Gastroenterology at Beijing Hospital between January 2022 and February 2025 were enrolled. Based on background gastric mucosal status, patients were assigned to either an H. pylori-related gastritis group or an AIG group. Clinical data, endoscopic manifestations, pathological characteristics, and outcomes of endoscopic submucosal dissection (ESD) were compared between the groups. Normally distributed continuous variables were compared using the independent-samples t-test, non-normally distributed continuous variables were evaluated using the Mann-Whitney U test, and categorical variables were compared using the χ2 test. Results: A total of 130 patients with EGC and precancerous lesions were enrolled, including 106 patients with H. pylori-related gastritis and 24 with AIG. The proportion of female patients was higher in the AIG group than in the H. pylori group (male-to-female ratio: 7∶17 vs. 66∶40; χ2=8.71, P=0.003). Compared with the H. pylori group, the AIG group had lower pepsinogen Ⅰ levels [11.5 (8.0, 20.8) vs. 66.5 (51.0, 108.0) μg/L; U=21.00, P<0.001], a lower pepsinogen Ⅰ/Ⅱ ratio [1.19 (0.67, 1.65) vs. 6.74 (4.92, 9.21); U=21.50, P<0.001], lower hemoglobin levels [(125±12) vs. (133±16) g/L; t=2.21, P=0.029], lower vitamin B12 levels [269 (230, 467) vs. 538 (394, 716) ng/L; U=454.00, P<0.001], and higher gastrin-17 levels [42.2 (13.8, 74.5) vs. 2.9 (1.9, 4.9) pmol/L; U=1 890.00, P<0.001]. Regarding lesion morphology, the AIG group was predominantly characterized by elevated-type lesions (0-Ⅰa+0-Ⅱa: 17/26, 65.4%), whereas mixed-type lesions were predominant in the H. pylori group (0-Ⅱa+0-Ⅱc: 65/129, 50.4%; χ2=23.31, P<0.001). The proportion of discolored lesions was higher in the AIG group than in the H. pylori group [30.8%(8/26) vs. 7.0%(9/129); χ2=12.54, P<0.001]. According to the Operative Link on Gastritis Assessment (OLGA) and Operative Link on Gastric Intestinal Metaplasia Assessment (OLGIM) staging systems, the AIG group was primarily classified as stage 2 [OLGA stage 2: 73.1%(19/26); OLGIM stage 2: 38.5%(10/26), whereas the H. pylori-related gastritis group was mainly categorized as stages 3-4 [OLGA stage 3: 38.8% (31/80); OLGA stage 4: 15.0% (12/80); OLGIM stage 3: 35.0%(28/80); OLGIM stage 4: 47.5% (38/80)], indicating that atrophy and intestinal metaplasia were both more extensive and severe in the H. pylori group. Conclusions: EGC and precancerous lesions in AIG and H. pylori-related gastritis exhibit distinct morphological and color characteristics, as well as differing risk stratifications under the OLGA and OLGIM staging systems. Consequently, different EGC follow-up and detection strategies should be adopted for AIG and H. pylori-related gastritis.