Helicobacter pylori , Betel Quid Chewing, and Endoscopic Pathology in Dyspeptic Patients: A Cross‐Sectional Analytical Study

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Abstract
Background: Helicobacter pylori ( H. pylori ) infection and betel quid (BQ) chewing are both highly prevalent in South Asia and are independently implicated in upper gastrointestinal mucosal injury, yet their joint contribution to endoscopic pathology in dyspeptic patients is poorly characterised. We aimed to describe the exposure profile of dyspeptic patients with and without endoscopic pathology, quantify the individual and joint associations of H. pylori and BQ use with pathology and explore trends with BQ exposure. Methods: In this cross‐sectional analytical study, 211 consecutive dyspeptic patients attending a tertiary gastroenterology department were classified as having endoscopic pathology (Group A, n = 141) or a normal endoscopic examination (Group B, n = 70). H. pylori status, BQ exposure (including a cumulative ‘BQ‐Quid‐Years’ index), and body mass index (BMI) were recorded, and multivariable logistic regression, additive‐interaction analysis and dose–response modelling were performed. Results: Group A patients were older (median 40 vs. 31 years, p = 0.009) and more often male (58.2% vs. 41.4%, p = 0.039) than Group B. Pathology prevalence rose stepwise from 52.2% in patients negative for both H. pylori and BQ use to 72.5% in patients positive for both (trend p = 0.076). The relative excess risk due to interaction (RERI) showed no clear evidence of departure from additivity (−0.16, 95% confidence interval [CI] −1.14 to 0.39), although the wide interval does not exclude synergistic or sub‐additive effects. After multivariable adjustment, male sex (adjusted odds ratio [aOR] 3.01, 95% CI 1.50–6.04, p = 0.002) and, more modestly, age (aOR 1.02, 95% CI 1.00–1.05, p = 0.039) were independently associated with pathology; H. pylori (aOR 1.38, p = 0.353) and BQ use (aOR 1.66, p = 0.219) showed positive but non‐significant associations. Conclusions: Male sex was the most robust, independently associated correlate of endoscopic pathology in dyspeptic patients, and age showed a more modest, independent association.

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