• Bakhtyar Faiq Salim Department of Medicine, College of Medicine, University of Sulaimani, Kurdistan Region, Iraq.



H. pylori, Gastritis, Peptic ulcer disease, GERD



Patients with reliable laboratory-proved H. pylori infection manifest gastritis on upper GI endoscopy and such gastritis is associated with various benign, pre-malignant, and malignant gastrointestinal disorders, but the frequency and the magnitude of such association are not clarified well in the literature. 


To show the endoscopic findings in symptomatic patients with proven H. pylori infection by non-invasive laboratory reliable tests namely urea breath test and stool Antigen testing and to show the relation between these endoscopic findings and the common associated finding namely duodenal, gastric ulcerations, and Gastro-esophageal reflux disease (GERD).


A cross-sectional descriptive study was carried out from August 2018 to January 2019. The study sample consisted of 314 patients who had symptoms of Helicobacter pylori and were referred to Kurdistan center for gastroenterology and Hepatology (KCGH) in Sulaimani, Iraqi Kurdistan, Iraq. All of the patients were proved to have H. pylori diagnosed with either urea breath test in 196 cases or stool antigen test in 118 cases. All of them had undergone endoscopy. Gastritis types and associated pathologies were diagnosed by high definition endoscopy and agreed upon by an expert Board qualified endoscopist. Histopathological confirmation was not carried out. Although there is inter-observer variability in the endoscopic diagnosis of gastritis, the patients being diagnosed by sensitive laboratory methods before endoscopy limits this variability, and it is well known that the most common cause of gastritis is H. pylori infection


The 314 symptomatic patients with lab-proven H. pylori infections were more middle-aged adults and more females than males. Most of these patients (97%) showed endoscopic evidence of gastritis. Antral and or fundal gastritis whether nodular or not, are more associated with duodenal ulceration while pangastritis and antral erosions are more associated with gastric ulcers. GERD is associated with gastritis alone without peptic ulceration, but it is more severe when there is duodenal ulceration and even more severe when the duodenal ulcers are complicated by gastric outlet obstruction, partial or complete.


Doing upper GI endoscopy for dyspeptic patients with lab-proven H. pylori infection to detect associated benign anad pre-malignant upper GI pathologies to plan the appropriate treatment and its duration. The test and treat strategy for symptomatic H. pylori infected patients without a red flag recommended by international guidelines may be suboptimal in areas with a high frequency of H. pylori infection like ours.


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