Clinical Significance of Gastric Wall Thickening Detected on Routine Abdominal Ultrasonography: Correlation with Endoscopic Findings and Helicobacter pylori Infection

Objective: Ultrasonography (US) is a commonly used non-invasive imaging method for evaluating the abdominal region. This study aims to evaluate the relationship between gastric wall thickening detected on routine abdominal ultrasonography, endoscopic and histopathological findings, and Helicobacter pylori (H. pylori) infection. Methods: We retrospectively analyzed 2478 abdominal ultrasonography reports performed for non-urgent indications. Gastric wall thickening of 5 mm or more was defined as abnormal. Patients with reported thickening who underwent endoscopy were included in the study. Demographic, endoscopic, histopathological, and H. pylori data were analyzed using age- and sex-adjusted ROC and multivariate logistic regression analyses. Results: Gastric wall thickening was detected in 150 patients (6.1%). Of these, 83 (55.3%) underwent endoscopy and 74 underwent biopsy. The most frequent finding was chronic inactive gastritis (73.0%), followed by chronic active gastritis (20.3%). H. pylori positivity was observed in 18.9% of cases. Gastric wall thickness was significantly higher in H. pyloripositive patients (p = 0.027). ROC analysis showed moderate performance, achieving 78.6% sensitivity and 60.0% specificity with a cutoff point of 5.5 mm (AUC: 0.749). Gastric wall thickness was independently associated with H. pylori positivity (OR: 1.651; p = 0.038). Conclusion: Gastric wall thickness was found to be significantly higher on ultrasonography, especially in patients with gastric malignancy and H. pylori positivity. Although ultrasonography does not replace endoscopic and histopathological evaluation, when applied carefully, it can be used as a non-invasive method supporting clinical decision-making as an early indicator of benign and malignant gastric pathologies.