**4. Clinical features**

The clinical presentation of *H. pylori* infection is highly variable. As many as 90% of individuals infected are asymptomatic, while the other 10% can present with dyspepsia, which is defined as epigastric discomfort/pain lasting longer than one month, that may be associated with other symptoms such as nausea, early satiety, epigastric fullness, and bloating. This is often diagnosed as functional dyspepsia [6]. Symptoms correlate poorly with the severity of gastric mucosal injury seen on endoscopy, and diagnosis is often missed and not treated in time, leading to chronic gastritis or peptic ulcer disease. Due to the delay in diagnosis, peptic ulcers can present with complications such as gastrointestinal bleeding and perforation [6]. Because *H. pylori* infection remains untreated, with time chronic inflammation can lead to atrophic gastritis, which is precancerous and can progress to gastric cancer [4]. At this stage, the patient often presents with alarm symptoms such as weight loss, anemia, dysphagia, recurrent vomiting, and an epigastric/abdominal mass. Sometimes chronic gastritis can lead to other cancers, such as gastric MALT lymphoma, which presents with dyspepsia and non-specific constitutional symptoms [6]. Rarely *H. pylori* may present with extragastrointestinal manifestations such as isolated iron deficiency anemia (IDA) and idiopathic thrombocytopenic purpura (ITP) [6].
