 Kurdistan Journal of Applied Research (KJAR) Print-ISSN: 2411-7684 | Electronic-ISSN: 2411-7706 Website: Kjar.spu.edu.iq | Email: kjar@spu.edu.iq Prevalence of Helicobacter pylori infection and its Associated Risk Factors among symptomatic Residents of Sulaimani city, Kurdistan region, Iraq, 2020 Seerwan Hama Rashid Ali Sabiha Sharif Salih Community health Department Laboratory Technic Department Technical College of Health Technical College of Health Sulaimani Polytechnic University Sulaimani Polytechnic University Sulaimani City, Iraq Sulaimani City, Iraq hseerwan@yahoo.com Sabiha_sh@yahoo.com Taib Ahmed Hama Sour Goran Mohammad Raouf Laboratory Technic Department Pathology and Forensic Pathology Department Technical College of Health College of Medicine Sulaimani Polytechnic University Sulaimani University Sulaimani City, Iraq Sulaimani City, Iraq dr.taibahmed@gmail.com Araz Latif Rahim Kurdistan Center for Gastroenterology and Hepatology Sulaimani Teaching Hospital goran.raouf@univsul.edu.iq Ministry of Health Sulaimani City, Iraq araz197575@gmail.com Article Info ABSTRACT Volume 6 – Issue 1- June 2021 DOI: 10.24017/science.2021.1.1 Article history: Received 29/4/2021 Accepted 11/6/2021 Helicobacter pylori (H. pylori) bacteria are a microaerobic Gram negative that colonizes in the gastric and duodenum of human. It can cause prolong infection in the human life if not treated. Many of the studies showed that infection by H. pylori can cause some important gastrointestinal illness, such as peptic ulcer, chronic gastritis, gastric adenocarcinoma and mucosa associated lymphoid tissue lymphoma. Recurrence is generally considered as H. pylori recrudescence infection after one year of eradicated treatment. There are many factors involved in the H pylori reinfection, such as the epidemiology of H. pylori infection, development of economical state, and health conditions. The Objectives of this study were to estimate the prevalence and determine the risk factors of infection by H. pylori bacteria in dyspeptic patients in Sulaimani city. the Aims of the study are to estimate prevalence of the H. pylori and patients’ characteristics in Sulaimani city. This is a cross-sectional study, using a Urea breath test or stained the gastric sample with Gimza stain, which is including all participants aged between (12-87) years during Keywords: Prevalence, Dyspepsia, Helicobacter pylori, Risk factor, Sulaimani. mailto:hseerwan@yahoo.com mailto:dr.taibahmed@gmail.com mailto:goran.raouf@univsul.edu.iq mailto:araz197575@gmail.com Kurdistan Journal of Applied Research | Volume 6 – Issue 1 – June 2021 | 2 the period starting from 1 January until 31 December 2020 on Iraqi male and female patients were visiting –Center for Gastroenterology and Hepatology in Sulaimani, city, Iraq. Three hundred and four patients were included, all of them underwent Urea breath test only but eighty-one of the participants underwent endoscopy and stained the gastric sample with Gimza stain. Results: the prevalence rate of H. pylori infection in our study is 54.9%, and mean age of the study participants was (40.49 ±16.39) one hundred and ninety-one cases 62.8% were female and one hundred and thirteen cases 37.2%were male. Infection by H. pylori bacteria is rife in dyspeptic patients; and is more common in the age group of 31-40 years. One of noninvasive test to diagnosis H. pylori is Urea breath test. In conclusions the rate of H. pylori infection in our study is 54.9% among the symptomatic patients, and the overall incidence of H. pylori UBT and Giemsa stain detection rate were 73.4 and 26.6% respectively. Copyright © 2019 Kurdistan Journal of Applied Research. All rights reserved. 1.INTRODUCTION The H. pylori bacterium is a gram negative, microaerophilic, has urease-production effect and spiral-shaped [1]. For the human life, the infection by H. pylori is considered as the most common chronic bacterial infection. [2, 3] the infection by H. pylori in More than half of the world's population which are causes chronic gastritis, in advanced stages of infection, the bacteria are associated with peptic ulcer and increased the chance of developing risk to stomach cancer.[4] Barry Marshall and Robin Warren, they were isolated H. pylori in 1982 for the first time. The bacterium is a gram-negative type and microaerophilic, and can causes inflammation in the gastric mucosa; it is the main causative agent of upper gastrointestinal diseases in the countries which have poor socio-economic status and not developed [5] Gastric antrum and areas of gastric metaplasia in the duodenum are the main habitat place for H. pylori [6]. The epithelial lining of the stomach is place of choice to invade by H. pylori. Clinical signs of H. pylori infection are abdominal distention, epigastric burning sensation, and nausea, but in most of the patients the infection will be asymptomatic. [7] In human the one of the main causes of peptic ulcer disease is infection by H. pylori, and it is one of the predisposing factors for gastric cancer. For treatment of the disease, the risk of recurrence reduction with avoidance of its complication results in ulcer healing. Best treatment needs using multi drugs including antibiotics and anti-acid for 10-14 days.[8] in 1983 the scientists’ discovery of H. pylori as a main cause of gastric and duodenal ulcer illness. [1] H. pylori is not like as majority of pathogenic bacteria, it is typically colonizing the host for life unless specific treatment is given human migration pattern correlates with strain types that predominate within certain regions of the world [9]. Disease evident is not common in most infected individuals, this conduct us to make the hypothesis that some type of H. pylori strains which are harmless or even have benefit effect; although, in the recent years show that the list of diseases caused by H. pylori infection has been increased will conclude that any strain is commensal [10]. Almost 50% of world population exposed to infection by Helicobacter pylori bacteria. There is clear distinction among developing and developed countries. The prevalence in Kurdistan Journal of Applied Research | Volume 6 – Issue 1 – June 2021 | 3 developing countries as Middle East, sub–Saharan Africa and Latin America was 90% or more, while it is 40% or less in developed countries like Swaziland, western Europe, north America and Australia [11]. Commonly infection of stomach is present patients infected by H. pylori and appear as acute or chronic. Gastritis may be, corpus or antral-predominant or spread.[12] the loss of acid secretion is accompanied the entire gastric which effected by acute gastritis [10]. Sometimes metaplasia and adenocarcinoma progressed [13]. Proton pump inhibitors mediates chronic acid suppression and it can lead to alter the antral predominant to pangastritis, the risk of cancer development does not increase by duodenal ulcers and antrum- predominant gastritis [14]. Gastric adenocarcinoma is mainly caused by Helicobacter pylori [15]. Some complications followed H. pylori infections which include ulceration that making by the part of the body that can damage the cell lining epithelium of the gastric and then acidity of the stomach help the progression and formation this type of ulcer, so H. pylori should be treated to avoid ulcer formation. In case of Stomach cancer: H. pylori considered as one of the risk factors for gastric carcinoma. Treatment for ten days by using Omeprazole, clarithromycin and amoxicillin or treating for fourteen days via using bismuth subsalicylate, tetracycline and metronidazole; or treating for ten to fourteen days by using lansoprazole, clarithromycin and amoxicillin, are the regimens that recommended for H. pylori eradication by the National Institute of Clinical Excellence. [16] the evidence illustrates that the Vaccination or treatment and eradication of h. pylori infection [17] may decrease the risk of stomach cancer and gastric ulcer. Because in Kurdistan region a few studies about prevalence of helicobacter pylori especially investigation via both Urea Breath Test and endoscopy finding and re-infection of stomach mucosa by helicobacter pylori bacteria. The aim of the current study is to discover the prevalence of helicobacter pylori and risk factors among dyspeptic patients visited Kurdistan Center for Gastroenterology and Hepatology in Sulaimani city in 2020. 2. Materials and Methods The Study population are included Iraqi male and female patients aged 12-87 years which are living in Sulaimani city and visiting Center for Gastroenterology and Hepatology in Sulaimani, city, Iraq. Sample size and technique We select 304 cases of dyspeptic patients referred to Kurdistan Center for Gastroenterology and Hepatology in 2020. Study area The selected study area was including center municipality of Sulaimani city and rural of it, the cases was visited the Kurdistan Center for Gastroenterology and Hepatology in Sulaimani city. Duration of the study The data collection time was started from 1 January 2020 to 31 December 2020. Study design A cross sectional design of the study, by using urea breathes test and staining of gastric biopsy histology (by applying it’s in Giemsa stain for 24 hours) was used as a diagnostic test. The study included dyspeptic cases aged (12-87 years) in 2020 and were subjected to routine upper gastro-intestinal endoscopy for suspected gastric infection, peptic ulcer disease and stomach cancer. Data Collection Method • Data was collected by applying the Questionnaire which include socio demographic characteristics, hygiene, lifestyle factor and behavioral of symptomatic patients. Kurdistan Journal of Applied Research | Volume 6 – Issue 1 – June 2021 | 4 • The urea breath test was done by using machine (Heliprobe® system, manufacture in Sweden) to detect H. pylori infection. Biopsy taking and laboratory diagnosis The endoscopic mucosal biopsy from gastric antrum mucosa and endoscopic mucosal biopsy from gastric erosion for histological diagnosis and staining by Giemsa stain. Statistical Analysis of Data All dyspeptic patients’ data are analyzed via application of the SPSS version 26. The descriptive of statistics put forward as (mean±SD) and frequencies as percentages, and Chi- square used for test group differences or categorical variables. In all statistical analysis, level of significant (p.value) set as ≤ 0.05 and the study results showed as figures and tables. The inclusion Criteria: All Patients presented by dyspeptic symptoms as (epigastric pain, heartburn, nausea, vomiting, early satiety, bloating) aged between 12-87 years were referred to KCGH; they were not previously screened or treated for H. pylori infection. Exclusion Criteria: Patients below 12 years, who had a history of PPI, H2 receptor antagonist, bismuth, warfarin, and steroid use within 2 weeks before, or antibiotic use within 4 weeks, active gastrointestinal bleeding, and history of gastric surgery and H. pylori eradication Pregnant women, and non- Iraqi participant. The human ethics: Ethical approval was taking from the community health department / Technical College of Health / Sulaimani Polytechnic University for doing this study. In addition, the permission was taken from KCGH center to conduct our study on H. pylori infection. Before the data collection an informed consent for each patient or from their parents in adolescent patient under 18 years are taking with signature of it and confidentially keeping our results. 3.RESULTS The response rate of the participants; To determine the rate of responses by participants, the following equation was used. The response rate = No of patient responded to questionnaire/N0 of sample size *100 = 304/323*100 = 94.1% Prevalence of H. pylori infection and demographic characteristics The current study includes 304 adult and adolescent’s dyspeptic patients who are living in Sulaimani city-and rural areas of Sulaimani, they were visiting Center for Gastroenterology and Hepatology during the period of 1 January until 31 December 2020. The total of 304 dyspeptic patients 167 of the patients were have a positive result for H. pylori infection, which are giving an overall incidence of 54.9%. Sixty-three (37.7%) male and one hundred and four (62.3%) of female participants were positive result for H. pylori but there was not statistically significant different in with the age, mean ± standard deviation (SD) (40.49 ±16.39) and the majority of participants age were in between (31-40) years old group, 75 (24.7%). The table.1 is summarized the socio-demographic characteristic of the studies participant. Kurdistan Journal of Applied Research | Volume 6 – Issue 1 – June 2021 | 5 Presence of gastric ulcer To investigate the presence of ulcer in dyspeptic participants have a role on their result of UBT for patients affected by H. pylori bacteria, the result showed that majority of dyspeptic patients who have positive result for H. pylori test were have ulcer in their stomach 92 (55.1%) and only 75 (44.9%) who not had ulcer in their stomach from dyspeptic patients and score result of H. pylori-infection, Statistically there was a significant relationship between presence of gastric ulcer of dyspeptic patients and their score of result of H. pylori-infection (p-value 0.0001). (Figure 1) Figure 1. Distribution of dyspeptic patient’s result regarding to present of gastric ulcer Table 1. prevalence of H. pylori-infection according to UBT result for dyspeptic participants which respect to socio demographic variables (N=304) Variables +ve UBT frequency -ve UBT frequency Total Percentage % p-value Sex Male 63 50 113 37.2 0.507* Female 104 87 191 62.8 Age ≤ 20 14 23 37 12.2 0.138 21-30 32 20 52 17.1 31-40 50 25 75 24.7 41-50 36 28 64 21.0 51-60 18 22 40 13.2 > 60 17 19 36 11.8 Residence Rural 39 50 89 29.3 0.044* Urban 128 87 215 70.7 Occupation 1)Student 19 30 49 16.1 0.009* 2)Government/ Employee 43 29 72 23.7 3)Medical Staff 23 12 35 11.5 4) Worker 25 14 39 12.8 0 20 40 60 80 100 120 140 positive Negative have gastric ulcer No have gastric ulcer Kurdistan Journal of Applied Research | Volume 6 – Issue 1 – June 2021 | 6 5)Housewife 54 41 95 31.3 6)Others/ unemployed 3 11 14 4.6 Education No legal education 16 25 41 13.5 0.326 Grade 1–6 33 28 61 20.1 Grade 7–12 56 35 91 29.9 Institute / University 62 49 111 36.5 Family size 1–3 / ˂ 4 49 30 79 26 0.160 > 3 / ≥4 118 107 225 74 H. pylori test result Negative (0) 49 88 137 45.1 0.00001* Mild (1) 24 39 63 20.7 Moderate (2) 31 41 72 23.7 Sever (3) 9 23 32 10.5 Economic state 1)Poor 80 69 149 49 0.253 2)Moderate 68 55 123 40.5 3)Rich/opulent 19 13 32 10.5 Blood Groups 1)Type A 47 35 82 27 0.488 2)Type B 22 22 44 14.5 3)Type O 91 73 164 53.9 4)Type AB 7 7 14 4.6 Rhesus (Rh) Rh + ve 161 128 289 95.1 0.566 Rh-ve 6 9 15 4.9 Nutritional State Under weight 13 13 26 8.6 0.446 Normal 67 50 117 38.5 Over weight 59 57 116 38.1 Obese 28 17 45 14.8 Present of gastric ulcer Yes 92 17 109 35.9 0.0001* No 75 120 195 64.1 *UBT: Urea Breath Test Table 2 Association of H. pylori prevalence detection with respect to hygiene, lifestyle factor and behavioral of symptomatic patients in KCGS in Sulimani City in 2020 (N=304). Variables +ve UBT frequency -ve UBT frequency total p-value Did you have Psychological disorder 1)Yes 133 89 222 0.005* 2)No 34 48 82 Family hx. of gastric ulcer 1)Yes 89 56 145 0.053 2)No 78 81 159 Eating meals at 1)home only 68 75 143 0.019* 2)Restaurant|&home 99 62 161 Drinking water source 1)Tap water 95 74 169 0.647 2)well water 17 20 37 3)Filtered water 55 43 98 Hand washing practice Yes 93 120 213 0.00001* No 74 17 91 Clinical symptoms Yes 163 116 279 0.001* No 4 21 25 Cigarette smoking/ Smoker Yes 16 18 34 0.718 Never 151 119 270 Alcohol drinking Yes 12 4 16 0.215 No 155 133 288 Diabetes mallets Yes 18 13 31 0.375 Kurdistan Journal of Applied Research | Volume 6 – Issue 1 – June 2021 | 7 *UBT: Urea Breath Test *KCGH: Kurdistan Center for Gastroenterology and Hepatology 4. DISCUSSION Dyspeptic patient’s and Prevalence of H. pylori Dyspepsia is a frequent issue in those seeking medical help and also the general public. It is diagnosed when signs are present that are considered to come from the gastro-duodenal zone (early satiety, Halitosis, Nausea, Distension of abdomen, Excessive burping, epigastric pain or burning) [19]. The occurrence of H. pylori infection within dyspeptic participants sent to KCGH in Sulaimani, city was 54.9 percent, which is consistent with a local analysis done by Bashdar Mohammed Hussein et al, in Hawler city, Kurdistan region [21] was (55.8 percent) also is approximately lower than the average Sheikhani, et al [20] in Sulaimani (62.7 percent), the outcome is smaller than those in nearby countries, such as Turkey 63% [22]. and indicated the same occurrence of H. pylori as other studies which done in Asia and the Middle East, by researcher Alazmi et al [24]. But study in Kuwait [23] was (49.7%) of the prevalence of H. pylori. This variance may be related to the nature of our research, which surveyed only dyspeptic patients admitted to Kurdistan Center for Gastroenterology and Hepatology in Sulaimani district, and due to their history, they could have a different life style in comparison of the rest of the community. In another study done by R.P. Jackman, et al in America, et al. [25] prevalence was only (10.4%). The explanation for this variance in H. pylori positivity frequency is most likely related to the size of sample differences; age ranges, geographic areas, socioeconomically aspects and time frames the studies were conducted. Relationship between demographic factors of dyspeptic patient’s and prevalence of H. pylori-infection Female dyspeptic participants were appeared to be more diagnosed with H. pylori than male dyspeptic patients in the present research (P value: 0.504). This was in contrast to what others have said [22]. It's possible that women stay more time in the kitchen and take more time in preparing food than men for cultural reasons; some time it could be due to menstrual or sex hormones. There is a different study on the association regarding infection with H. pylori occurrence and patient ages. Extremely similar incidence was found by researcher (Dorji et al., 2013) in Bhutan city [26] and by (Zhang et al., 2013) in China [27], with non-significant differences between age groups. Likewise, previous research undertaken in other countries found no substantial connection between infection by helicobacter pylori and patient ages [28, 29]. This is in line with our results, which found that there was not statistically significant link regarding age and infection with H. pylori bacteria (p.value 0.138). Wubejig Abebaw et al. (2014) [30] stated a relationship between age with occurrence of Helicobacter pylori infection. The frequency of infection with H. pylori was shown larger in dyspeptic patients from city environments than in those from rural regions in this research. Living conditions are becoming denser, with a large number of families residing in a small region of Sulaimani, increasing the possibility of water and air pollution. And our results demonstrate this case by statistically significant (p.value 0.044). According to the findings of AL-Mashhadany et al RJLBPCS 2018 [31], males in rural and urban regions have a higher occurrence of Helicobacter pylori antibodies, with 41.3 % and 38.2 %, respectively. Ndipetal. (2004) [32] Found that the H. pylori-infection prevalence it differs between rural and urban populations. Dyspeptic patients who work different occupations in their life, the outcome demonstrates that more statistically significant (P < 0.009). Abdurahaman Seid et al (2018) [33] found a No 149 124 273 Method of diagnosis 1)Endoscopy&UBT 37 44 81 0.002* 2)UBT 130 93 223 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5991442/#CR22 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5991442/#CR33 Kurdistan Journal of Applied Research | Volume 6 – Issue 1 – June 2021 | 8 substantial relationship between kind of career and occurrence of H. pylori-infection. This finding is in line with the results of a report from Northwest Ethiopia in (2018) [30], but not with those of Dorji et al. (2013) [26], According to the findings of our research, patients who work as housewives are more probable to have infection by H. pylori than those who have other profession. There was no statistically relevant correlation regarding socioeconomic status and H. pylori occurrence in this research (p=0.253). This contradicts a report conducted in Erbil (Bashdar Hussen et al., 2013) [21]. As to the educational achievement of the dyspeptic patients, our research demonstrates that the highest rate of infection with H. pylori was noted in the patients who finished Institute/university degree (p.value 0.021), numerically a strong relation was observed between H. pylori occurrence and academic achievement, which due to going to check their gastric and test in order to detect them self about bacterial infection as H. pylori. This result is similar to other findings of the study which done in developed countries; similarly, no statistically relevant correlation was identified regarding H. pylori occurrence and degree of school achievement, which are consistent with other study done in Ethiopian [28]. While high number of family size is recognized as a potential cause for infection by H. pylori pathogenic bacteria [35], the family size in a house do not show any significant cause occurrence of H. pylori infection in our research (p.value 0.160). This conclusion is in line with the finding of an Iranian explorer (Mansouri-Ghanaei et al., 2009) [36]. This research also observed a non-significant interaction among ABO blood groups and UBT findings (p.value 0.488), which is compatible with other researches that found no significant relationship [37, 28]. But in our research, there was no statistically relevant relationship between Rhesus (Rh) blood group and H. pylori occurrence (p=0.566). Large percentage of dyspeptic patients in our study revealed that they are overweight in nutritional state (38.5%), accompanied by normal according to body mass index (BMI) (38.5%), then obese and underweight (14.8%), (8.6%) respectively. Despite the fact that there is no association between dyspeptic patients and body mass index in our research (p.value 0.446), this is compatible with the results of Solhpour A. et al [38]. In terms of gastrointestinal ulcers, it was discovered that individuals with peptic ulcers are more probability to infected by H. pylori pathogen (55.1 %) than others who did not have any ulcers. Majority of peptic ulcer events are triggered by bacteria of H. pylori, because it is transmission between the familial member; statistically, there was a significant correlation regarding gastric ulcer of patients and their score of outcomes of H. pylori-infection (p.value 0.0001). the result of our study is in line with the outcomes of Ghalia Khoder et al. in the United Arab Emirates in 2019 [39]. Relationship between H. pylori prevalence and it’s respected to behavioral, lifestyle factors and hygienic issue for dyspeptic participants The current research reveals that the majority of dyspeptic patients had a psychological disorder, considering the fact that 73% of all participants in this study had a psychological disorder, and 79.6% of positive H. pylori-infection patients in our research had this concern. The current research found a statistically significant negative relationship between frequency and psychiatric illness (p.value 0.05), which is compatible with many another research (takeoka et al., 2017; Seid et al., 2015). [41, 33] And about gastrointestinal features, it found that people who have family background of peptic ulcer disease were more 53.3% susceptible to infection by Helicobacter pylori. In addition, the present analysis reported that is a relatively irrelevant correlation between the occurrence of Helicobacter pylori-infection and a family background of gastric ulcer disease (p.value 0.053). These results are in compatible with a finding of Muhammad O. et al. and Ramin Nikman et al. [42, 43] Kurdistan Journal of Applied Research | Volume 6 – Issue 1 – June 2021 | 9 In this research, the dyspeptic positive patients who ate and ingested food in a restaurant or from a street vendor made up 59.3 percent of all dyspeptic participants, contrary to other patients who only ate and ingested food at home, with a significant relationship (p.value 0.019). Our findings are consistent with findings from other countries, such as Taweesak Tongtawee et al [40] in Thailand, who reported a significant connection regarding dyspeptic patients who ate and ingested food from a restaurant or a street vendor and occurrence of H. pylori-infection (p.value 0.01); That can be attributed to the fact that many pathogenic bacteria such as H. pylori, Escherichia coli and another pathogenic microbe can sometime contaminate the street vendor and restaurant. Is also thought that the occurrence of H. pylori various depending on the water source for consumption. In our study, show that H. pylori and water forms were not correlated with a drinking source (P vale: 0.647). This is related to a study in Erbil that found no connection between sources of drinking water and H. pylori (P vale: 0.738). (Bashdar Hussen et al., 2013) [21]. this is may be attributed to brand new developments in drinking water supply and essential utilities. Our analysis found that washing hands has a greater probability of preventing infection by H. pylori and has highly significant impact on H. pylori occurrence (p.value 0.00001), which contradicts the findings of Abdurahaman Seid et al (2018) [33]. Although bad hygiene is thought to be a significant risk factor for H. pylori illness, such as lack of home sanitation facilities (Dube et al., 2009) [34]. Other investigators have found anomalies which demonstrate that hygienic activity is not important in terms of H. pylori occurrence (Alizadeh et al., 2009) [45]. In term of clinical gastrointestinal symptoms, in those with gastrointestinal symptoms such as (Heartburn, Halitosis, Vomiting, Dyspepsia and Epigastric pain) the overall frequency of 97.6% positive H. pylori was recorded (p.value 0.001) However, our results show that the incidence of Helicobacter pylori was correlated substantially with dyspeptic patient clinical gastrointestinal symptoms. This is equivalent to other discoveries made in Jordan by Hamed Alzoubi et al. (2020) [44], and it is also similar to the findings of Sheikhani et al [20]. We also investigated the relationship in dyspeptic patients between cigarette smoking and positivity of H. pylori infection, we find anomalies that in our study there was no statistically significant difference between cigarette smoking and positive rate of Helicobacter pylori-infection (p.value 0.718), and this consistent with the finding of Mohie Khalifa in Saudi Arabia [18]. Regarding to relation between alcohol intake and the occurrence of infection with H. pylori is widely conflicted. In our research, there was no significantly important relation between alcohol intake and positivity occurrence of H. pylori infection (p=0.215). This is agreed with the finding performed in Sulaimani done by (Muhammad. O et al., 2018) [42]. A large percentage of dyspeptic patients in our sample indicated that they did not have Diabetes Miletus (89.2 % of all members with positive H. pylori bacteria results), with insignificant relationship between Diabetes Miletus and H. pylori occurrence in our research (p.value 0.375). This conclusion is line with the observations of Jafarzadeh's 2011 research in Iran's south-east [45]. Finally, in accordance with the methods of testing, the findings of our study revealed that an individual was 73.4 % more detected the infection by H. pylori by UBT route. And, based on this ratio of individuals, the present analysis shows that over half (58.3 %) of dyspeptic patients was positive for H. pylori by UBT screening; clinically, statistically there was non- significant relation between occurrence of helicobacter pylori and techniques of diagnosis (p.value 0.350). This result is compatible with the conclusions of research made in Jordan by Hamed Alzoubi et al in 2020 [44]. 5. Acknowledgements Thanks to assistant professor doctor Muhammed B. Mina the Deans of the Technical College of Health for his cooperation. We like to thank Dr. Goran M. Raouf, Mr. Hawar Taha Mina and Abbas Osman Husein in the KCGH, and Muhammed S. Qader for their cooperation. Kurdistan Journal of Applied Research | Volume 6 – Issue 1 – June 2021 | 10 Thanks for the all participants. Special thanks to Dr. Taib Ahmed Hama Sour and assistant professor Sabiha Sharif Salih for critically reviewing the manuscript. 6. CONCLUSION In conclusions: our study showed that prevalence of H. pylori was 54.9% among dyspeptic patients in Sulaimani City, Most of H. pylori patients in Sulaimani city are females. The Patients who had positive for H. pylori infection via UBT have more endoscopic findings than others with negative H. pylori via UBT it is endemic in Kurdistan region and Iraq but the continuously is higher in incidence across (31-40) age groups despite significant community frequent antibiotic use or abuse of it, UBT is non-invasive and plain test to diagnosis gastric infection by H. pylori. The overall H. pylori UBT and Gimza stain identify rate were 73.4 and 26.6% respectively. Even also statistically significant and agreement between results of UBT and Giemsa stain was not strongly convincing. H. pylori-prevalence was statistically significant associated with Residence, occupation, Psychological disorder, place of eating meals, Hand washing practice, present of clinical symptoms and present of gastric ulcer. But no significant association observed between other lifestyle factors and sociodemographic variables as Family history of gastric ulcer, source of drinking water, Cigarette smoking, Alcohol drinking and Diabetes mallets of dyspeptic patients and H. pylori UBT detection. REFERENCE [1]B. Marshall and J. R. Warren, “Unidentified curved bacilli in the stomach of patients with gastritis and peptic ulceration,” Lancet, vol. 323, no. 8390, pp. 1311–1315, 1984. [2]A. Kandulski, M. Selgrad, and P. Malfertheiner, “Helicobacter pylori infection: a clinical overview,” Dig. Liver Dis., vol. 40, no. 8, pp. 619–626, 2008. [3]D. J. McGee, C. A. May, R. M. Garner, J. M. Himpsl, and H. L. Mobley, “Isolation of Helicobacter pylori genes that modulate urease activity,” J. Bacteriol., vol. 181, no. 8, pp. 2477–2484, 1999. [4]D. R. Cave, “Transmission and epidemiology of Helicobacter pylori,” Am. J. Med., vol. 100, no. 5A, pp. 12S-17S; discussion 17S-18S, 1996. [5]R. E. Pounder and D. Ng, “The prevalence of Helicobacter pylori infection in different countries,” Aliment. Pharmacol. Ther., vol. 9 Suppl 2, pp. 33–39, 1995. [6]J. Parsonnet et al., “Helicobacter pyloriInfection and the risk of gastric carcinoma,” N. Engl. J. Med., vol. 325, no. 16, pp. 1127–1131, 1991. [7]T. T. Schubert, A. B. Schubert, and C. K. Ma, “Symptoms, gastritis, and Helicobacter pylori in patients referred for endoscopy,” Gastrointest. Endosc., vol. 38, no. 3, pp. 357–360, 1992. [8]L. N. Meurer and D. J. Bower, “Management of Helicobacter pylori Infection,” Am. Fam. Physician, vol. 65, no. 7, p. 1327, 2002. [9]J. Fox, “The non-H. Pylori helicobacter: their expanding role in gastrointestinal and systemic diseases.” . [10]R. Suzuki, S. Shiota, and Y. Yamaoka, “Molecular epidemiology, population genetics, and pathogenic role of Helicobacter pylori,” Infect. Genet. Evol., vol. 12, no. 2, pp. 203–213, 2012. [11]S. Mishra, “Is Helicobacter pylori good or bad?,” Eur. J. Clin. Microbiol. Infect. Dis., vol. 32, no. 3, pp. 301–304, 2013. [12]F. A. Baban, University of Sulaimani, M. O. Mohammad, and University of Sulaimani, “The prevalence of Helicobacter pylori in upper gastrointestinal disorders,” J. Zankoy Sulaimani - A, vol. 6, no. 1, pp. 1–8, 2003. Kurdistan Journal of Applied Research | Volume 6 – Issue 1 – June 2021 | 11 [13]J. G. Kusters, A. H. M. van Vliet, and E. J. Kuipers, “Pathogenesis of Helicobacter pylori infection,” Clin. Microbiol. Rev., vol. 19, no. 3, pp. 449–490, 2006. [14]P. C. Konturek, S. J. Konturek, and T. Brzozowski, “Helicobacter pylori infection in gastric cancerogenesis,” J. Physiol. Pharmacol., vol. 60, no. 3, pp. 3–21, 2009. [15]S. S. Kim, V. E. Ruiz, J. D. Carroll, and S. F. Moss, “Helicobacter pylori in the pathogenesis of gastric cancer and gastric lymphoma,” Cancer Lett., vol. 305, no. 2, pp. 228–238, 2011. [16]“Helicobacter Pylori (H. Pylori) Infection,” in The APRN and PA’s Complete Guide to Prescribing Drug Therapy, New York, NY: Springer Publishing Company, 2019. [17]P. Sutton and Y. T. Chionh, “Why can’t we make an effective vaccine against Helicobacter pylori?,” Expert Rev. Vaccines, vol. 12, no. 4, pp. 433–441, 2013. [18]M. M. Khalifa, R. R. Sharaf, and R. K. Aziz, “Helicobacter pylori: a poor man’s gut pathogen?,” Gut Pathog., vol. 2, no. 1, p. 2, 2010. [19]D. Varia, P. Malfertheiner, F. Megroud, A. T. Axon, M. Deltenre, and A. M. Hirschl, “Diagnosis of Hehicobacter pylori infection with a new non-invasive antigen based assay,” Lancet, vol. 354, pp. 30–3, 1999. [20]A. Mohamma, A. Taha, and T. Pshko, “Helicobacter Pylori infection among Dyspeptic Patients Referred for Endoscopy,” Zanco J Med Sci, vol. 14, pp. 37–43, 2010. [21]M. Bashdar, S. Saleem, F. Halgurd, and H. Suha, “The Prevalence of Helicobacter pylori among University Students in Iraq,” Indian Journal of Science & Technology, vol. 8, pp. 5020–5023, 2013. [22]T. Yucel, D. Aygin, S. Sen, and O. Yucel, “The prevalence of Helicobacter pylori and related factors among university students in Turkey,” Jpn. J. Infect. Dis., vol. 61, no. 3, pp. 179–183, 2008. [23]W. M. Alazmi, I. Siddique, N. Alateeqi, and B. Al-Nakib, “Prevalence of Helicobacter pylori infection among new outpatients with dyspepsia in Kuwait,” BMC Gastroenterol., vol. 10, no. 1, p. 14, 2010. [24]K. L. Goh, “Prevalence of and risk factors for Helicobacter pylori infection in a multi-racial dyspeptic Malaysian population undergoing endoscopy,” J. Gastroenterol. Hepatol., vol. 12, no. 6, pp. S29-35, 1997. [25]R. P. Jackman, C. Schlichting, W. Carr, and A. Dubois, “Prevalence of Helicobacter pylori in United States Navy submarine crews,” Epidemiol. Infect., vol. 134, no. 3, pp. 460–464, 2006. [26]D. Dorji, T. Dendup, H. M. Malaty, K. Wangchuk, D. Yangzom, and J. M. Richter, “Epidemiology of Helicobacter pylori in Bhutan: the role of environment and Geographic location,” Helicobacter, vol. 19, no. 1, pp. 69–73, 2014. [27]B. Zhang, G. Y. Hao, and F. Gao, “Lack of association of common polymorphisms in MUC1 gene with Helicobacter pylori infection and non-cardia gastric cancer risk in a Chinese population.” 2013. [28]T. Dilnessa and M. Amentie, “Prevalence of Helicobacter pylori and risk factors among dyspepsia and non-dyspepsia adults at Assosa General Hospital, West Ethiopia: a comparative study,” Ethiop J Health Dev, vol. 31, no. 1, 2017. [29]M. Petrović et al., “Relationship between Helicobacter pylori infection estimated by 14C-urea breath test and gender, blood groups and Rhesus factor,” Hell. J. Nucl. Med., vol. 14, no. 1, pp. 21–24, 2011. [30]W. Abebaw, M. Kibret, and B. Abera, “Prevalence and risk factors of H. pylori from dyspeptic patients in northwest Ethiopia: a hospital based cross-sectional study,” Asian Pac. J. Cancer Prev., vol. 15, no. 11, pp. 4459–4463, 2014. [31]A. Dhary, “AL-Mashhadany,’,” KURDISTAN REGION, IRAQ: Life Science Informatics Publications,2018. Kurdistan Journal of Applied Research | Volume 6 – Issue 1 – June 2021 | 12 [32]N. R. Ndip, E. A. Malange, and T. F. J. Akoachere, “Helicobacter pylori antigens in the feces of asymptomatic children in the Buea and Limbe health districts of Cameroon: a pilot study.” 2004. [33]A. Seid and W. Demsiss, “Feco-prevalence and risk factors of Helicobacter pylori infection among symptomatic patients at Dessie Referral Hospital, Ethiopia,” BMC Infect. Dis., vol. 18, no. 1, 2018. [34]C. Dube, N. F Tanih, A. M Clarke, N. Mkwetshana, E. Green, and R. N Ndip, “Helicobacter pylori infection and transmission in Africa: Household hygiene and water sources are plausible factors exacerbating spread,” Afr. J. Biotechnol., vol. 8, no. 22, pp. 6028–6035, 2009. [35]O. Herbarth, P. Krumbiegel, and G. J. Fritz, “Helicobacter pylori prevalence and risk factors among school beginners in a German urban centre and its rural county.” 2010. [36]F. Mansour-Ghanaei, Y. M. Mashhour, and F. Joukar, “Prevalence of Helicobacter pylori infection among children in Rasht, Northern Iran,” Middle East J Dig Dis, vol. 1, pp. 84–8, 2009. [37]H. G, “Prevalence and risk factors of Helicobacter pylori among adults at jinka zonal hospital, debub omo zone, southwest Ethiopia,” Autoimmune Infect. Dis., vol. 2, no. 2, 2016. [38]A. Solhpour et al., “Relationship between uninvestigated dyspepsia and body mass index: a population- based study,” East Afr. J. Public Health, vol. 7, no. 4, pp. 318–322, 2010. [39]G. Khoder, J. S. Muhammad, I. Mahmoud, S. S. M. Soliman, and C. Burucoa, “Prevalence of Helicobacter pylori and its associated factors among healthy asymptomatic residents in the United Arab Emirates,” Pathogens, vol. 8, no. 2, p. 44, 2019. [40]T. Tongtawee et al., “Characteristics and risk factors of Helicobacter pylori associated gastritis: A prospective cross-sectional study in northeast Thailand,” Gastroenterol. Res. Pract., vol. 2016, p. 9130602, 2016. [41]A. Takeoka et al., “Psychological effects of Helicobacter pylori-associated atrophic gastritis in patients under 50 years: A cross-sectional study,” Helicobacter, vol. 22, no. 6, 2017. [42]O. Mohamme, “Clinical, Endoscopic and Urea Breath Test Among Dyspeptic Patients Referred to Kurdistan Center for Gastroenterology and Hepatology in Sulaimani,” International Journal of Clinical Medicine, vol. 5, pp. 1180–1188, 2018. [43]R. Niknam, M. Seddigh, M. R. Fattahi, A. Dehghanian, and L. Mahmoudi, “Prevalence of Helicobacter pylori in Patients With Dyspepsia,” Jundishapur J. Microbiol., vol. 7, no. 10, p. e12676, 2014. [44]H. Alzoubi et al., “The use of 13C-urea breath test for non-invasive diagnosis of Helicobacter pylori infection in comparison to endoscopy and stool antigen test,” Diagnostics (Basel), vol. 10, no. 7, p. 448, 2020. [45]J. A1, R. Mt, and N. M, “Helicobacter pylori seropositivity in patients with type 2 diabetes mellitus in south-east of Iran,” Acta Med Iran, vol. 51, no. 12, 2013.