Clinical Spectrum, Endoscopic Findings, and Eradication Outcomes of Helicobacter pylori Infection in Eastern Libya

Abstract

Helicobacter pylori (H. pylori) is a highly prevalent global infection and a major cause of gastrointestinal morbidity. Despite its high endemic burden in Libya, localized data regarding clinical characteristics, endoscopic findings, and treatment outcomes following standardized eradication therapy remain limited. To evaluate the demographic characteristics, clinical presentations, upper gastrointestinal endoscopic findings, and treatment outcomes among patients diagnosed with H. pylori infection in Derna, Libya. A prospective observational study was conducted between 2024 and 2025, involving 55 consecutive patients (aged ≥15 years) with confirmed H. pylori infection diagnosed via stool antigen testing. All patients received a 14-day first-line triple therapy (amoxicillin, clarithromycin, lansoprazole). Patients with persistent infection received a 10-day second-line bismuth-based quadruple therapy. Eradication success was confirmed via follow-up stool antigen testing at least four weeks post-treatment. Clinical symptoms and upper endoscopic findings were systematically recorded and analyzed. The mean age of the cohort was 26.6 ± 9.0 years, with a near-equal sex distribution (52.7% female). Epigastric pain (76.4%) and nausea (52.7%) were the most frequent presenting symptoms. First-line triple therapy achieved an eradication rate of 85.5% (47/55 patients), with a highly significant reduction in post-treatment stool antigen titers (median: 4.0 to <1.0; p < 0.001). Treatment efficacy showed no significant difference between sexes (p = 1.000). The remaining 14.5% (8 patients) were successfully transitioned to second-line bismuth quadruple therapy. Among the 47.3% of patients who underwent endoscopy, atrophic gastritis was the predominant finding (38.5%), followed by esophagitis (23.1%). Baseline endoscopic pathology did not significantly influence therapeutic success. In eastern Libya, H. pylori infection predominantly affects young adults presenting with dyspeptic symptoms. A 14-day standard triple therapy demonstrates a clinically acceptable eradication rate comparable to regional and global averages. Stool antigen testing proves highly effective for both initial diagnosis and eradication confirmation. These findings provide valuable real-world data to support and optimize current H. Pylori management strategies in resource-limited Libyan settings.