Objectives: The aim of this study was to investigate the prevalence of gastric premalignant changes as gastric atrophy, intestinal metaplasia and dysplastic changes in patients underwent esophagogastroduodenoscopy in three health institutions in Karbala province. Methods: The data was collected from patients attended the endoscopy units during a period from January  to September 2018 in three medical centers in holy Karbala/ Iraq, Al Hussein teaching hospital, Imam Zain Al Abedin hospital and Imam AL Hujjah hospital. It includes 215 males and 285  females who were subjected to esophagogastroduodenoscopy (EGD) from whom mucosal biopsies were taken. These biopsies were stained by Giemsa to detect H. pylori organisms. Results: The mean age of patients was (40.9 +/- 15 years SD). H. Pylori infection was demonstrated in (71%) patients, (19.4%) were presented with glandular atrophy, (7.4%) out of 500 patients had intestinal metaplasia and only 6 (1.2%) patients had dysplastic changes. there was a significant statistical relation between gastric glandular atrophy and age, p value (0.03). there was a significant statistical relation between glandular atrophy and infection with H. Pylori, p value (0.001). there was a significant negative relation between H. Pylori infection and the existence of intestinal metaplasia, p value (0.0001). this study show a significant statistical relationship between the existence of intestinal metaplasia and the occurrence of  dysplastic changes, P value (0.001).  Conclusion: the current study show a significant relation between aging and the existence of gastric glandular atrophy. There was a significant relation between each of gastric glandular atrophy and intestinal metaplastic changes with the H. pylori infection. there was a significant relation between gastric intestinal metaplasia and dysplastic changes.

BACKGROUND: Helicobacter pylori is an important gastrointestinal infective bacteria with many serious complications including gastric erosions and ulceration, duodenal ulcer, gastric carcinoma and MALT gastric lymphoma. The gastric biopsy is commonly performed in H. pylori-positive dyspeptic individuals, and many previous researchers studied the histopathological features of infected gastric biopsies however little previous studies focused on the histopathological findings in young population in comparison to the older one. AIM: To make a focus on the histopathological effects of H. pylori infection in young patients compared with the older one and predicts the need for endoscopy in this population, also to estimates the prevalence of infection in Iraqi patients. MATERIAL AND METHODS: the sample for this study is 180 patients in total, they attended Marjan medical city in Iraq for dyspepsia of more than 3 months and prepared for OGD. Patients asked for their permission to do immunological tests for H. pylori. Both serology for H. pylori antibodies and stool for antigen tests are used, and the case is included in the study only if both tests were positive, after OGD, the gastric biopsies are processed and examined histopathologically. RESULTS: Normal gastric biopsy is the most common histopathological finding in young (< 25 years) patients (75%) while chronic atrophic gastritis is the most common one in patients > 25 years age (57%). The prevalence of Helicobacter pylori infection in dyspeptic patients was 73.3%, the correlation between infection and sex was insignificant (p-value 0.06), and no significant correlation between infection and age (p-value 0.07) was concluded. CONCLUSION: H. pylori-related histopathological changes of gastric mucosa in young (< 25 years) are commonly mild and does not necessitate endoscopy at this age unless there are alarming signs.