Helicobacter pylori burden and chronic gastritis in women previously treated for breast cancer with persistent dyspepsia: a retrospective comparative endoscopic biopsy study

Background Persistent dyspepsia in women previously treated for breast cancer is often attributed to treatment-related or functional causes, but its gastric histopathological basis remains poorly defined. This study compared laboratory profiles and upper gastrointestinal biopsy findings in women previously treated for breast cancer and symptomatic women without breast cancer. Methods We retrospectively analysed 104 women who underwent upper gastrointestinal endoscopy for treatment-resistant dyspeptic symptoms: 43 women previously treated for breast cancer and 61 controls. Continuous variables are reported as median [interquartile range] and were compared using two-sided Mann-Whitney U tests. Histopathological biopsy scores were analysed as ordinal 0–3 outcomes and as binary indicators of any abnormality. Fisher's exact test was used for binary comparisons, and age-adjusted proportional-odds models were fitted for ordinal biopsy severity. False-discovery-rate adjustment was applied within laboratory and biopsy-outcome families. Results The groups were similar in age: 60.0 [53.0-66.5] versus 57.0 [48.0–70.0] years; p = 0.646. Albumin was lower in the breast cancer group after adjustment for multiple comparisons: 44.8 [42.0-46.1] versus 47.0 [43.6–50.0] g/L; p = 0.001; q = 0.020. Chronic inflammation was present in all patients in the breast cancer group compared with 75.4% of controls: risk difference, 24.6%; 95% CI, 12.4–36.7%; p < 0.001. The age-adjusted ordinal inflammation score was higher in the breast cancer group: adjusted OR, 5.62; 95% CI, 2.51–12.58; q < 0.001. H. pylori positivity was more frequent in the breast cancer group: 60.5% versus 26.2%; risk difference, 34.2%; 95% CI, 15.0-50.4%; p < 0.001, with higher age-adjusted density scores: adjusted OR, 7.83; 95% CI, 3.33–18.37; q < 0.001. Neutrophil activity, intestinal metaplasia, atrophy and dysplasia did not differ significantly after adjustment. Conclusions Women previously treated for breast cancer who underwent endoscopy for treatment-resistant dyspepsia showed higher chronic inflammation scores and greater H. pylori density than symptomatic controls. Persistent upper gastrointestinal symptoms in this population may therefore be associated with potentially treatable gastric pathology. These findings are hypothesis-generating and warrant prospective studies incorporating detailed oncological, hormonal and microbiome-related variables.