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As their symptoms frequently overlap with those of\n                      <jats:italic>Helicobacter pylori<\/jats:italic>\n                      infection, a leading cause of gastrointestinal illness, coinfections may be overlooked. This study aimed to determine the prevalence of intestinal protozoal infections among patients referred for\n                      <jats:italic>H. pylori<\/jats:italic>\n                      stool testing and to explore their association with clinical symptoms and risk factors.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A cross-sectional study was conducted on 150 patients presenting with gastrointestinal complaints. Stool samples were examined using comprehensive parasitological techniques, along with ELISA for\n                      <jats:italic>Entamoeba histolytica\/dispar<\/jats:italic>\n                      and\n                      <jats:italic>H. pylori<\/jats:italic>\n                      antigens.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Intestinal protozoa were detected in 36.9% of participants, most commonly\n                      <jats:italic>Blastocystis<\/jats:italic>\n                      spp. (33.3%), followed by\n                      <jats:italic>E. dispar<\/jats:italic>\n                      (5.3%) and\n                      <jats:italic>E. coli<\/jats:italic>\n                      (2.7%).\n                      <jats:italic>Giardia lamblia<\/jats:italic>\n                      ,\n                      <jats:italic>Dientamoeba fragilis<\/jats:italic>\n                      , and\n                      <jats:italic>Cyclospora cayetanensis<\/jats:italic>\n                      were detected in only four patients. All\n                      <jats:italic>Entamoeba<\/jats:italic>\n                      infections were negative for\n                      <jats:italic>E. histolytica-<\/jats:italic>\n                      specific antigen.\n                      <jats:italic>H. pylori<\/jats:italic>\n                      antigen was positive in 35.3% of participants. The prevalence of intestinal protozoa did not differ significantly between\n                      <jats:italic>H. pylori<\/jats:italic>\n                      -positive and\n                      <jats:italic>H. pylori<\/jats:italic>\n                      -negative patients (39.6% vs. 34%); however,\n                      <jats:italic>Blastocystis<\/jats:italic>\n                      spp. was significantly associated with higher\n                      <jats:italic>H. pylori<\/jats:italic>\n                      antigen concentrations. Both protozoal and\n                      <jats:italic>H. pylori<\/jats:italic>\n                      infections were significantly associated with the source of drinking water but showed no significant association with age or sex. Abdominal pain was the predominant symptom among all patients, regardless of\n                      <jats:italic>H. pylori<\/jats:italic>\n                      or protozoal infection status. Notably, 78% of patients referred for\n                      <jats:italic>H. pylori<\/jats:italic>\n                      testing had not concurrently undergone parasitological examination, of whom 37.6% were subsequently found to have protozoal infections.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      This study demonstrates a high prevalence of intestinal protozoal infections, predominantly\n                      <jats:italic>Blastocystis<\/jats:italic>\n                      spp., among patients undergoing\n                      <jats:italic>H. pylori<\/jats:italic>\n                      evaluation, and identifies a significant association between\n                      <jats:italic>Blastocystis<\/jats:italic>\n                      and elevated\n                      <jats:italic>H. pylori<\/jats:italic>\n                      antigen levels. The overlapping symptoms and frequent underdiagnosis of protozoal infections in clinical practice support the incorporation of routine parasitological examination alongside\n                      <jats:italic>H. pylori<\/jats:italic>\n                      testing in patients presenting with gastrointestinal symptoms, with the potential to improve diagnostic accuracy and patient management.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s13099-026-00841-5","type":"journal-article","created":{"date-parts":[[2026,6,7]],"date-time":"2026-06-07T06:16:11Z","timestamp":1780812971000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Burden of intestinal protozoan parasites coinciding with Helicobacter pylori infection in patients with gastrointestinal symptoms"],"prefix":"10.1186","volume":"18","author":[{"given":"Amel Youssef","family":"Shehab","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mona Mohamed","family":"Tolba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali Ali Mohammed","family":"Alrabeei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heba S.","family":"Ibrahim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hend","family":"El-Taweel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,7]]},"reference":[{"issue":"3","key":"841_CR1","doi-asserted-by":"publisher","first-page":"127","DOI":"10.14740\/gr1622","volume":"16","author":"M Ahmed","year":"2023","unstructured":"Ahmed M. 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