In this study, 233 patients with gastrointestinal diseases were first examined for H. pylori infection and then patients were divided into positive and negative groups for H. pylori infection. Demographic data showed that H. pylori infection is significantly higher in married people, with more than 3 family members, and people with a history of cancer. Also, the incidence of gastrointestinal symptoms including epigastric pain, weight loss and loss of appetite in H. pylori positive patients were significantly higher than H. pylori negative patients. Various studies have suggested that factors such as age, congestion, increasing number of family members and low level of health, especially in childhood, are the main causes of infection with this organism [16-18].
Age is one of the most important factors in the development of H. pylori infection and many recent studies showed a significant association between this factor and the incidence of H. pylori infection . In a study conducted by Rowland et al., (2006) revealed that young children before the age of 3 years are at risk for H pylori whereas the risk of infection is very low after 5 years of age. In the present study, most people (59.5%) with H. pylori were in the 35-45 age group . Similar to our results, Toyoshima et al., (2017) reported that patients at age ranges between 40 to59 significantly have higher serum antibody titer for H. pylori than other age groups .
In this study, the incidence rate of H. pylori infection in different sexes was not statistically significant. Of course, the results of many studies in consistent with our study, showed that H. pylori infection is not sex dependent. In current study, BMI, Number of family member, Smoking, Alcohol drink and Education were not significant risk factors in patients with H. pylori infection. While smoking and alcohol consumption factors are the confirmed important factors in the incidence of H. pylori infection, but no difference has been observed in the present study. Education is one of the factors that are inversely related to the incidence of H. pylori infection, and people with higher education are less likely to suffer from this type of disease . However, in the present study, no significant relationship was observed between education and the incidence of H. pylori infection. The number of family members was one of the items evaluated in this study and had no significant relationship with the incidence of H. pylori infection. In many studies, the opposite results have been reported to our study. It is hypothesized that with the increase in the number of family members, the amount of contact with the outside environment increases, the contact of indoor people with each other increases and can increase the incidence of disease .
The highest endoscopic finding in this study was gastric mucosal erosion, which was observed in 98 (42.1%) patients. Based on the endoscopic results of gastric mucosal erosions, there was a significant difference between gastric and duodenal mucosal erosions, and duodenal mucosal erosions were more common in H. pylori positive patients. In 72.4 and 80.9% of patients infected by H. pylori infection, gastric mucosal erosion and duodenum mucosal erosion was observed, respectively. Past studies showed that more than 90% of duodenal ulcers and 60% of gastric ulcers are associated with H. pylori infection . In this study, gastrointestinal ulcer endoscopy was significantly higher in patients with H. pylori than in the normal group. In logistic multivariate analysis, H. pylori infection was independently associated with endoscopic wound. On the other hand, peptic ulcer and gastritis are increasing in patients who are negative for H. pylori and cover at least 30% of these patients [24, 25]. The results of other studies differ from ours. In the study conducted by Chu et al., (2005) H. pylori negative patients had more gastrointestinal bleeding .
Comparison of pathological findings in patients with and without H. pylori infection showed that the neutrophil infiltration was the highest finding which was observed in 124 (53.2%) patients . The results of this study showed that the incidence and severity of neutrophil infiltration findings in the mucosal layer and propriolar muscularity, normal gastric glands, complete intestinal metaplasia and incomplete intestinal metaplasia were significantly more reported in H. pylori positive patients.
In current work 75.8% of patients with H. pylori showed neutrophil infiltration in the mucosal layer and propria muscularity signs were reported. Also, incomplete intestinal metaplasia and complete intestinal metaplasia were reported in 100% and 96.4% of cases. Intestinal metaplasia is characterized by the loss of mucus-secreting capillaries and their replacement by the epithelium containing goblet cells which manifests in three forms and the third type is called as incomplete intestinal metaplasia.
In a similar work, Fontham et al., (1995) indicated that 87% of patients with gastric cancer were associated with intestinal metaplasia and had significant differences with normal controls . Silva concluded in a study that the highest prevalence of H. pylori occurs in the area where there is incomplete intestinal metaplasia and this type of metaplasia indicates long-term damage to the mucosa and leads to cancer . There are different statistics on the prevalence of H. pylori in chronic gastritis and intestinal metaplasia. Therefore, many studies have been trying to find a way to link the direct or indirect effects of H. pylori to histological findings, especially dysplasia and gastric cancer. The results showed that users of non-steroidal anti-inflammatory drugs showed gastrointestinal symptoms such as heartburn, reflux, weight loss, loss of appetite and also the use of drugs such as diabetes and heart drugs also mentioned the symptoms of heartburn, reflux, weight loss, loss of appetite, premature satiety, the presence of blood in the stool and iron deficiency anemia.