Prevalence of Helicobacter pylori infection in patients with upper gastrointestinal disorders using different methods in Khuzestan, Southwest Iran.

Background: Helicobacter pylori (H. pylori) has been strongly associated with gastroduodenal pathologies, including gastritis, peptic ulcers, and gastric cancer. This study aimed to determine the prevalence of H. pylori infection in Khuzestan Province, Southwest Iran, identify demographic and clinical predictors, and evaluate the effect of proton pump inhibitors (PPIs), antibiotics, and bismuth on the accuracy of diagnostic tests.

Methods And Results: In this cross-sectional study, 550 patients (aged 12-94 years) with gastrointestinal disorders underwent upper endoscopy. Demographic data, medication history, and endoscopic findings were recorded. Four antral biopsies per patient were collected and analyzed for H. pylori infection using the rapid urease test (RUT), histology, culture, and polymerase chain reaction (PCR) for confirmatory testing. Univariate logistic regression assessed the effects of medications on diagnostic results. The overall prevalence of H. pylori infection was 51.8% (285/550). Histology demonstrated higher sensitivity than RUT and culture. After adjustment for age and sex, the 31-40-year and 41-50-year age groups exhibited significantly higher odds of infection compared to the ≤ 30-year reference group. Multivariate analysis identified melena, duodenal ulcer, antral nodularity, and hiatal hernia as independent predictors of infection. Recent use of PPIs, antibiotics, or bismuth reduced the sensitivity of both RUT and histology; however, histology retained greater diagnostic reliability.

Conclusions: The high prevalence of H. pylori infection in Khuzestan Province emphasizes the development of eradication programs. Melena, duodenal ulcer, and antral nodularity are key clinical predictors. The novel association between H. pylori infection and hiatal hernia requires further studies to understand the underlying mechanisms. When discontinuing PPIs, antibiotics, or bismuth before testing is impractical in order to minimize false negatives, combining PCR with histology can improve diagnostic accuracy.