Intestinal Metaplasia and Helicobacter pylori: An Endoscopic Biopsy Study of Detection Rates and Associated Factors in a Libyan Population

Abdulfattah Fitouri Rajab¹, Mumajed Elmsellati², Mustafa Aldaqrum², Wisamuldin Omar², Hebatallah Fitouri³, Ala Habas3, Elmukhtar Habas⁴

Keywords: Gastric intestinal metaplasia, GIM, Helicobacter pylori, gastric cancer, Libya, identified rate

DOI: 10.63475/yjm.v5i2.0437

DOI URL: https://doi.org/10.63475/yjm.v5i2.0437

Publish Date: 20-07-2026

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Pages: 390 - 396

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Author Affiliation:

1 Consultant, Internal Medicine Department, Tripoli Central Hospital, Tripoli, Libya
2 Resident, Internal Medicine Department, Tripoli Central Hospital, Tripoli, Libya
3 Resident, Faculty of Medicine, University of Tripoli, Tripoli, Libya
4 Professor and Senior Consultant, Hamad General Hospital, Qatar University College of Medicine, Doha, Qatar

Abstract

Background: Gastric intestinal metaplasia (GIM) is a recognized premalignant lesion in the Correa cascade, yet its prevalence and associated factors remain poorly characterized in Libya. This study aimed to estimate the endoscopic biopsy detection rate of GIM and examine its associations with Helicobacter pylori infection, age, and sex in a Libyan endoscopic cohort.

Methods: This retrospective cross-sectional study included 442 patients who underwent esophagogastroduodenoscopy with gastric biopsy of macroscopically abnormal mucosa at Tripoli Central Hospital between January 2022 and August 2023. Data on age, sex, GIM, H. pylori status, and chronic gastritis were collected. Associations were assessed using chi-square tests, odds ratios, and logistic regression.

Results: Of the 442 patients included, 272 (61.5%) were female, and 170 (38.5%) were male; the median age was 40 years (interquartile range, 24–53 years; range, 2–94 years). GIM was present in 28 patients (6.3%), H. pylori infection in 300 (67.9%), and chronic gastritis in 439 (99.3%). Age group was significantly associated with GIM (χ² = 14.7, P = 0.022), with the highest detection rate in the 51 to 60 years (12.7%) and 61 to 70 years (14.7%) age groups. In multivariable analysis, patients aged 51 to 60 years (adjusted odds ratio [aOR], 4.03 [95% CI, 1.04–15.60]; P = 0.044) and 61 to 70 years (aOR, 4.86 [95% CI, 1.09–21.80]; P = 0.039) had significantly higher odds of

GIM compared with those aged ≤20 years. Neither sex nor H. pylori infection was independently associated with GIM. H. pylori positivity declined with increasing age.

Conclusions: In this biopsy-selected Libyan cohort—in which only patients with macroscopically abnormal mucosa underwent sampling—the GIM detection rate was 6.3%—a figure that likely underestimates the true disease burden given the non-systematic biopsy protocol. Increasing age was the strongest independent factor associated with GIM, with significantly elevated odds in adults aged 51 to 70 years (aOR, 4.03–4.86), while neither sex nor current H. pylori infection status emerged as an independent predictor. Larger population-based studies using standardized biopsy protocols are needed to establish accurate prevalence estimates and evaluate whether targeted surveillance of adults aged ≥50 years is warranted in Libya.

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