Association of Helicobacter pylori and Intestinal Parasitic Infections with Anaemia among Dyspeptic Patients in Benghazi, Libya: A Cross-Sectional Study

Abstract

Background and objectives. Helicobacter pylori and intestinal parasites are both common in low- and middle-income settings, and each can lower haemoglobin through blood loss, malabsorption, or chronic inflammation. While both pathogens are prevalent, their concurrent presence and association with haematological parameters among symptomatic patients require further clarification. This study aimed to investigate the prevalence of H. pylori and intestinal parasitic infections among adult dyspeptic patients in Benghazi, Libya, and to evaluate their association with haematological parameters and anaemia.

Methods. A hospital-based cross-sectional study was carried out at Benghazi Medical Centre among 304 adults systematically selected from outpatient gastroenterology referrals for investigation of persistent dyspepsia. A stool sample from each patient was tested for H. pylori antigen using a commercial enzyme-linked immunosorbent assay (ELISA) kit, examined microscopically for parasites by direct wet mount and formol-ether sedimentation, and screened for faecal occult blood. Complete blood counts were obtained on an automated haematology analyser (Sysmex KX-21N) within 2 hours of blood collection. Multivariable binary logistic regression was performed to adjust for potential confounders such as age and sex, reporting Adjusted Odds Ratios (aOR) with 95% Confidence Intervals (CI). Proportions were compared with the chi-square test and means with independent-samples t-tests.

Results. H. pylori antigen was detected in 89 of 304 patients (29.3%). Within this group, 15 patients (16.9%) carried Giardia lamblia, 7 (7.9%) Entamoeba histolytica, and 56 (62.9%) had a positive faecal occult blood test. Anaemia was present in 80 of the 89 infected patients (89.9%) compared with 3 of 215 uninfected patients (1.4%; p < 0.001). On multivariable logistic regression, H. pylori infection remained independently associated with a significantly higher likelihood of anaemia (aOR = 210.5, 95% CI: 58.2–761.4, p < 0.001). Mean haemoglobin (9.5 ± 2.0 vs 12.3 ± 1.4 g/dL, p < 0.001), haematocrit (29.1 ± 5.9 vs 36.3 ± 4.3%, p < 0.001), red cell count (3.8 ± 0.82 vs 4.3 ± 0.4 × 1012/L, p = 0.009), and platelet count (138.8 ± 53.5 vs 282.7 ± 54.4 × 109/L, p < 0.001) were all lower in infected patients, while the white cell count was higher (10.6 ± 3.6 vs 5.9 ± 1.5 × 109/L, p < 0.001).

Conclusions. In this clinic population, H. pylori infection was strongly associated with anaemia, lower red cell parameters, and alterations in white cell and platelet counts. A substantial minority of infected patients carried intestinal protozoa. Given the cross-sectional study design and small co-infected subgroups, these findings demonstrate significant clinical associations rather than direct synergistic causality. Integrated screening for gastric and intestinal pathogens in dyspeptic patients with anaemia is recommended.