الفهرس 
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Abstract
Gastrointestinal infections are the major causes of morbidity and mortality worldwide, particularly in developing countries. The causes of gastrointestinal diseases include a wide variety of bacteria, viruses, and parasites (Shaldoum et al., 2017). In many low-income and resource-limited regions, especially in tropical and rural areas, individuals are co-infected with multiple microorganisms, such as bacteria and parasites (Mcardle et al., 2018). So, there is a need to explore the magnitude of concurrent infection and the possible shared risk factors that may contribute to the co-occurrence of microorganisms in a single host (Tay et al., 2016).
Intestinal parasitic infections such as Giardia lamblia, Entamoeba histolytica, and Enterobius vermicularis are among the most common infections worldwide. It is estimated that 3.5 billion people are affected, nearly two-thirds of the world are infected with one kind of intestinal parasite, and 450 million are ill due to these infections (Shaldoum et al., 2017).
Helicobacter pylori (H.pylori) is a gram-negative, helical-shaped, motile bacillus bacterium, which colonizes the gastric mucosa (Krzyzek and Gosciniak, 2017). Infection with H. pylori has a reported annual incidence of 0.3-0.7% in developed countries, and 6-14 % in developing countries (Logan and Walker 2001). chronic infections with this microorganism can contribute to the development of various gastrointestinal complaints, including gastritis, gastric and duodenal ulcers, gastric cancers, or mucosa-associated lymphoid tissue (MALT) lymphomas (Valenzuela et al., 2015).
Normally, the acidic stomach environment prevents the survival of viruses, bacteria, parasites, and other microorganisms. H. pylori bacterium has evolved to be uniquely suited to thrive in the harsh stomach environment. It secretes urease, a special enzyme that converts urea to ammonia (Kazemian et al., 2016). Ammonia reduces the stomach’s acidity. This risk factor allows pathogenic intestinal protozoa such as G.lamblia to take the opportunity to cross through the stomach’s increased pH and cause disease (Shaldoum et al., 2017).
This study aimed to compare the prevalence of intestinal parasitic infection among positive and negative H.pylori infected outpatients in Sohag University Hospital.
200 stool samples collected from individuals who attended outpatient clinics in Sohag University Hospital (100 samples with positive H. pylori antigen as a case group and 100 samples with negative H. pylori antigen as a control group, The H. pylori test had already been performed using immuno-chromatographic test (ICT) for identification of H. pylori Ag in stool sample) with age ranging from 2 to 72 years (Mean ± SD = 25.410 ± 15.987). They had to fulfill the criteria not taking antibiotics within the previous 4 weeks, proton pump inhibitors within the previous 2 weeks or anti-parasitic drugs within the previous 2 weeks before sample collection.
All samples were examined by microscopic examination including direct mount, formalin ethyl-acetate sedimentation concentration technique and modified Kinyoun’s acid-fast staining.
The present study revealed that co-infection rate of H.pylori and intestinal parasites was (42%) in the case group (positive H.pylori patients) with age ranging from 3 to 71years (Mean ± SD = 24.350±15.179) and the prevalence of the detected parasites was 24% for G.lamblia, 14% for Cryptosporidium, 12% for E.histolytica, 11% for Blastocystis Hominis, 7% for E.coli, 6% for I.buetschilii, 4% for Cyclospora 2% for Ent.vermicularis, 3% for H.nana and 2% for A.lumbricoides. While the prevalence of the intestinal parasites in the control group (H.pylori free individuals) was 13% with age ranging from 2 to 72 years (Mean ± SD = 26.290±16.785) and the prevalence of the detected parasites was G.lamblia 3%, Cryptosporidium 2%, E.histolytica 10%, Blastocystis Hominis 2%, E.coli 6%, I.buetschilii 4%, Cyclospora 3%, Ent.vermicularis 3%, H.nana 2%, A.lumbricoides 3%.
These results were analyzed and revealed that there was great association between H.pylori and intestinal parasites prevalence among cases and controls and G.lamblia, Cryptosporidium and B. hominis were prevalent in H. pylori patients than H. pylori free ones with significant differences.
Conclusion
Gastrointestinal parasites are more common among H. pylori patients compared to individuals without H. pylori; there was high prevalence (42%) of co-infection of H.pylori with intestinal parasites in Sohag university hospital. G.lamblia, Cryptosporidium and B. hominis were prevalent in H. pylori patients than H. pylori free ones with significant differences. But this infection rate was not affected by gender. The highest infection rate was reported in the (< 15) and (15-30) year age groups among H. pylori patients and (> 30-45) year age group among the control individuals.
Co-infection remains a complex biological problem that must be approached from broad epidemiological as well as molecular-level studies to maximally decrease the impact. H.pylori may support the colonization by intestinal parasites or vice versa. The interaction between H. pylori and intestinal parasites may have serious health consequences.
Interactions between H. pylori, parasites, and the host are under the influence of multiple factors including immune responses, gut barrier function and gut microbiome and hence subject to variable clinical consequences. Co-infection with protozoa may worsen gastric pathology but co-infection with helminths may be potentially beneficial. The gastric outcomes are largely mediated by the balance between Th1 and Th2 responses.
Recommendations
The findings indicate that in addition to searching for H. pylori in gastrointestinal symptomatic patients, screening for giardiasis and cryptosporidiosis in patients is recommended for successful management of upper gastrointestinal symptomatic patients. And treating of the gastrointestinal parasites is a must when treating H. Pylori.
To better understand the relationship between H. pylori and intestinal parasites, there is a need for more comprehensive studies that include more patients, use high-sensitivity methods such as PCR.