Abstract
Background/aim
Helicobacter pylori (H. pylori) can transform from its spiral form into a coccoid (viable but non-culturable; VBNC) state under adverse environmental conditions. The coccoid form is associated with antibiotic resistance and eradication failure. This study compared coccoid and spiral form proportions, H. pylori localization patterns (epithelial vs. crypt), and gastric inflammation parameters across three BMI-stratified groups.Materials and methods
This retrospective comparative study included 156 H. pylori-positive cases from the archives of Karamanoglu Mehmetbey University Faculty of Medicine (2016-2026). Groups: Group 1 (Severe obesity/Sleeve, BMI ≥ 35; sleeve gastrectomy, n = 55), Group 2 (Non-obese/Biopsy, BMI Results
Median corpus coccoid proportion was significantly higher in Group 1 (10%, IQR 5-30) vs. Group 2 (1%, IQR 1-1; p Conclusion
Obesity was strongly associated with a coccoid-shifted H. pylori morphology (higher coccoid proportion) and with increased corpus crypt colonization. In this cohort the ≥ 40% coccoid category was observed exclusively in the severe obesity/sleeve group; this cut-off should be regarded as exploratory and hypothesis-generating, and requires external validation before it can be considered a histological signature of severe obesity. Because specimen type differed between groups and eradication outcomes were not assessed, these findings represent associations rather than causal relationships. IHC-based morphological assessment may be useful in obese and severely obese HP-positive patients, and prospective studies are warranted to determine whether coccoid burden and BMI can inform individualized eradication strategies.