Decade of decline: Unraveling Helicobacter pylori trends in Northwest China

doi:10.3748/wjg.121414

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Observational Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastroenterol. Dec 7, 2026; 32(45): 121414
Published online Dec 7, 2026. doi: 10.3748/wjg.121414

Decade of decline: Unraveling Helicobacter pylori trends in Northwest China

Zi-Qin Zeng, Hai-Yan Yang, Liu-Ying He, Ceng Sun, Jin-Hai Wang, Lei Dong, Jun Gong, Lu Li, Ping Zhao

Zi-Qin Zeng, Hai-Yan Yang, Liu-Ying He, Ceng Sun, Jin-Hai Wang, Lei Dong, Jun Gong, Lu Li, Ping Zhao, Department of Gastroenterology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710004, Shaanxi Province, China

Co-corresponding authors: Lu Li and Ping Zhao.

Author contributions: Zeng ZQ wrote the manuscript; Zeng ZQ and Zhao P conceived and designed the study and analyzed the data; Yang HY, He LY, Sun C, Wang JH, Dong L, Gong J, and Li L contributed to data analysis, literature review, and manuscript revision; Li L and Zhao P played important and indispensable roles in the experimental design as co-corresponding authors; all authors have read and approved the final manuscript.

AI contribution statement: AI tools were used solely for linguistic refinement and formatting assistance. No AI tool was involved in the generation of research data, interpretation of results, or formulation of conclusions. All AI-generated outputs were critically reviewed and revised by the authors.

Institutional review board statement: The study protocol was approved by the Medical Ethics Committee of the Second Affiliated Hospital of Xi’an Jiaotong University (No. 2024-134).

Informed consent statement: As a retrospective study utilizing existing clinical data, we performed no interventions on patients, collected no patient samples, and disclosed no personal information. Informed consent was waived, as this does not affect patients’ rights or health. The study protocol, including the statistical analysis plan, was reviewed and approved by the same committee that conducts integrated scientific and ethical review of all clinical studies.

Conflict-of-interest statement: The authors report no relevant conflicts of interest for this article.

STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.

Data sharing statement: The datasets generated and analyzed during the current study are not publicly available due to patient privacy concerns but are available from the corresponding author on reasonable request.

Corresponding author: Ping Zhao, MD, Chief Physician, Department of Gastroenterology, The Second Affiliated Hospital of Xi’an Jiaotong University, No. 157 Xiwu Road, Xincheng District, Xi’an 710004, Shaanxi Province, China. peggyzhao@163.com

Received: March 25, 2026
Revised: May 18, 2026
Accepted: June 25, 2026
Published online: December 7, 2026
Processing time: 204 Days and 13.3 Hours

Abstract

BACKGROUND

Helicobacter pylori (H. pylori) infection is a major risk factor for gastric cancer. The northwestern region of China has a high prevalence of this condition; therefore, long-term trend data from this region are highly valuable for optimizing gastric cancer prevention efforts.

AIM

To evaluate the prevalence and trends of H. pylori infection in Northwest China from 2014 to 2023.

METHODS

This retrospective, cross-sectional study was a large-scale investigation. General data for outpatients who underwent the ¹³C-urea breath test for H. pylori infection at a tertiary hospital in Northwest China from 2014 to 2023 were analyzed on the basis of sex, age, and year of testing.

RESULTS

This study included 69633 participants. The age-standardized prevalence of H. pylori infection decreased from 38.72% in 2014 to 27.94% in 2023, with similar decreasing trends observed across all age and sex subgroups. According to subgroup analyses, the infection rates for both sexes gradually shifted from an initial lack of difference to a trend in which males were more commonly infected than females (interaction P value < 0.001). Logistic regression with restricted cubic splines revealed a nonlinear relationship between age and infection risk; the risk increased with age up to age 29.64 [odds ratio = 1.06, 95% confidence interval (CI): 1.05-1.06, P < 0.001], after trended downward (odds ratio = 0.99, 95%CI: 0.99-0.99, P < 0.001).

CONCLUSION

The prevalence of H. pylori in Northwest China decreased substantially from 2014 to 2023, with a rapid decline in women. A nonlinear association between age and infection risk was identified, with a distinct inflection point.

Keywords: Helicobacter pylori infection; Prevalence; Trend analysis; Sex differences; Age

Core Tip: In this large-scale study, trends in Helicobacter pylori infection in northwest China over a decade were analyzed using data from 69633 outpatients. Our study identified three main findings. First, infection rates declined across all subgroups. Second, there was initially no significant difference in infection rates between the two sexes; however, infection rates among females declined faster than those among males, leading to the emergence and a progressive widening of sex disparity. Third, age and infection risk exhibited a nonlinear relationship with an inflection point. These findings provide evidence to guide targeted gastric cancer prevention strategies.