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            <front>

                <journal-meta>
                                                                <journal-id>pam tıp derg</journal-id>
            <journal-title-group>
                                                                                    <journal-title>Pamukkale Medical Journal</journal-title>
            </journal-title-group>
                                        <issn pub-type="epub">1308-0865</issn>
                                                                                            <publisher>
                    <publisher-name>Pamukkale Üniversitesi</publisher-name>
                </publisher>
                    </journal-meta>
                <article-meta>
                                        <article-id pub-id-type="doi">10.31362/patd.1747044</article-id>
                                                                <article-categories>
                                            <subj-group  xml:lang="en">
                                                            <subject>General Surgery</subject>
                                                            <subject>Psychiatry</subject>
                                                    </subj-group>
                                            <subj-group  xml:lang="tr">
                                                            <subject>Genel Cerrahi</subject>
                                                            <subject>Psikiyatri</subject>
                                                    </subj-group>
                                    </article-categories>
                                                                                                                                                        <title-group>
                                                                                                                        <trans-title-group xml:lang="tr">
                                    <trans-title>Endoskopi uygulanan hastalarda anksiyete düzeyinin helicobacter pylori, gastrik metaplazi ve diğer gastrik bulgularla ilişkisi</trans-title>
                                </trans-title-group>
                                                                                                                                                                                                <article-title>The relationship of anxiety level with helicobacter pylori, gastric metaplasia and other gastric findings in patients undergoing endoscopy</article-title>
                                                                                                    </title-group>
            
                                                    <contrib-group content-type="authors">
                                                                        <contrib contrib-type="author">
                                                                    <contrib-id contrib-id-type="orcid">
                                        https://orcid.org/0000-0001-9481-7756</contrib-id>
                                                                <name>
                                    <surname>Bolat</surname>
                                    <given-names>Hacı</given-names>
                                </name>
                                                                    <aff>NİĞDE ÖMER HALİSDEMİR ÜNİVERSİTESİ</aff>
                                                            </contrib>
                                                    <contrib contrib-type="author">
                                                                    <contrib-id contrib-id-type="orcid">
                                        https://orcid.org/0000-0001-7293-1646</contrib-id>
                                                                <name>
                                    <surname>Kurt</surname>
                                    <given-names>Aydın</given-names>
                                </name>
                                                                    <aff>NİĞDE ÖMER HALİSDEMİR ÜNİVERSİTESİ, TIP FAKÜLTESİ</aff>
                                                            </contrib>
                                                                                </contrib-group>
                        
                                        <pub-date pub-type="pub" iso-8601-date="20260413">
                    <day>04</day>
                    <month>13</month>
                    <year>2026</year>
                </pub-date>
                                        <volume>19</volume>
                                        <issue>2</issue>
                                        <fpage>391</fpage>
                                        <lpage>400</lpage>
                        
                        <history>
                                    <date date-type="received" iso-8601-date="20250721">
                        <day>07</day>
                        <month>21</month>
                        <year>2025</year>
                    </date>
                                                    <date date-type="accepted" iso-8601-date="20250929">
                        <day>09</day>
                        <month>29</month>
                        <year>2025</year>
                    </date>
                            </history>
                                        <permissions>
                    <copyright-statement>Copyright © 2008, Pamukkale Tıp Dergisi</copyright-statement>
                    <copyright-year>2008</copyright-year>
                    <copyright-holder>Pamukkale Tıp Dergisi</copyright-holder>
                </permissions>
            
                                                                                                <trans-abstract xml:lang="tr">
                            <p>Amaç: Bu çalışmayla anksiyete seviyesi ile helicobacter pylori (H.pylori), gastrik metaplazi ve diğer gastrik lezyonlar arasındaki ilişki göstererek anksiyetenin mide prekanseröz lezyonlara olan etkisini araştırmak.Gereç ve yöntem: Genel cerrahi kliniğinde mide şikayeti nedeniyle endoskopi yapılan ve eş zamanlı olarak Beck Anksiyete Ölçeği ile anksiyete seviyesine bakılan hastalar çalışmaya alındı. Katılımcıların anksiyete seviyeleri normal, hafif, orta ve şiddetli olarak sınıflandırıldı. Endoskopik olarak peptik ulkus (PU), gastro özofagial sfikter (GÖS), gastrit, mide ülseri, midede kitle, polip, reflü ve hiatal herninin olup olmamasına bakıldı. Patolojik örneklerde de lezyonda helikobakter pylori (H.pylori), gastrik metaplazi (G. metaplazi), gastrik displazi (G.displazi), gastrit, gastrik atrofi, lenfoid agregat ve malignite olup olmasına bakıldı. Anksiyete seviyesi ile endoskopik ve patolojik tanılar arasındaki ilişki değerlendirildi.Bulgular: Çalışmaya endoskopi işlemi yapılan ve Beck Anksiyeti ölçeği uygulanan 120 hasta alındı. Çalışmaya alınan hastaların yaş ortalaması 49,09 ve %56,7’si kadındı. Anksiyete seviyesi ile antral gastrit (AG), gastrik ülser (GÜ), pangastrit, reflü özefajit (RÖ), hiatal herni (HH), gastrik polip (GP), alkali gastrit (AG) ile istatiksel olarak anlamlı bir ilişki saptanamazken; anksiyete seviyesiyle GÖS gevşek (r:0,252, p:0,004), P.ulkus (r:-0,177, p:0,047), H.pylori (r:-0,141, p:0,034), intestinal metaplazi (r:-0,120, p:0,048) ve malignite (r:0,199, p:0,025) arasında anlamlı bir ilişki olduğu gözlendi.Sonuç: Çalışmada anksiyete seviyesinin yüksek olmasının başta gastrik metaplazi ve gastrik malign lezyonlar olmak üzere GÖS gevşek ve H. pylori oluşmasına sebep olduğu tespit edildi.</p></trans-abstract>
                                                                                                                                    <abstract><p>Purpose: This study aims to examine the effect of anxiety on gastric precancerous lesions by revealing the relationship of anxiety level with helicobacter pylori (H. pylori), gastric metaplasia and other gastric lesions.Materials and methods: Patients, who underwent endoscopy due to stomach complaints in the general surgery clinic and whose anxiety levels were measured simultaneously with the Beck Anxiety Inventory, were included in the study. Anxiety levels of the participants were categorized as normal, mild, moderate and severe. Endoscopically, whether there were peptic ulcus (PU), loose gastroesophageal sphincter (GES), gastritis, gastric ulcer, stomach mass, polyp, reflux and hiatal hernia were investigated. In pathological samples, the existence of H. pylori, gastric metaplasia (G. metaplasia), gastric dysplasia (G. dysplasia), gastritis, gastric atrophy, lymphoid aggregate and malignancy were examined. The relationship of anxiety level with endoscopic and pathological diagnoses was evaluated.Results: The study included 120 patients undergoing endoscopy and completing the Beck Anxiety Scale. The mean age of the patients was 49.09 years, while 56.7% of them were female. While no statistically significant relationship was found between anxiety level and antral gastritis (AG), gastric ulcer (GU), pangastritis, reflux esophagitis (RE), hiatal hernia (HH), gastric polyp (GP), alkaline gastritis (AG), a significant relationship was observed between anxiety level and loose GES (r:0.252, p:0.004), P. ulcus (r:-0.177, p:0.047), H. pylori (r:-0.141, p:0.034), intestinal metaplasia (r:-0.120, p:0.048) and malignancy (r:0.199, p:0.025).Conclusion: This study revealed that high anxiety level may cause P. ulcus, GES looseness and H. pylori positivity in addition to gastric metaplasia and gastric malign lesions.</p></abstract>
                                                            
            
                                                                                        <kwd-group>
                                                    <kwd>Anxiety</kwd>
                                                    <kwd>  helicobacter pylori</kwd>
                                                    <kwd>  metaplasia</kwd>
                                                    <kwd>  endoscopy</kwd>
                                            </kwd-group>
                            
                                                <kwd-group xml:lang="tr">
                                                    <kwd>Anksiyete</kwd>
                                                    <kwd>  helicobacter pylori</kwd>
                                                    <kwd>  metaplazi</kwd>
                                                    <kwd>  endoskopi</kwd>
                                            </kwd-group>
                                                                                                                                    <funding-group specific-use="FundRef">
                    <award-group>
                                                                            <award-id>2022/28</award-id>
                                            </award-group>
                </funding-group>
                                </article-meta>
    </front>
    <back>
                            <ref-list>
                                    <ref id="ref1">
                        <label>1</label>
                        <mixed-citation publication-type="journal">Köksal AŞ, Oğuz D, Özden A. Prevalence of dyspepsia in patients applying to primary health care institutions in Türkiye. Akademik Gastroenteroloji Dergisi. 2008;7(1):11-17.</mixed-citation>
                    </ref>
                                    <ref id="ref2">
                        <label>2</label>
                        <mixed-citation publication-type="journal">Marshall BJ, Warren JR. Unidentified curved bacilli in the stomach of patients with gastritis and peptic ulceration. The Lancet. 1984;323(8390):1311-1315. doi:10.1016/S0140-6736(84)91816-6</mixed-citation>
                    </ref>
                                    <ref id="ref3">
                        <label>3</label>
                        <mixed-citation publication-type="journal">Sun Q, Yuan C, Zhou S, et al. Helicobacter pylori infection: a dynamic process from diagnosis to treatment. Front Cell Infect Microbiol. 2023;19(13):1257817. doi:10.3389/fcimb.2023.1257817</mixed-citation>
                    </ref>
                                    <ref id="ref4">
                        <label>4</label>
                        <mixed-citation publication-type="journal">Hooi JKY, Lai WY, Ng WK, et al. Global prevalence of Helicobacter pylori infection: systematic review and meta-analysis. Gastroenterology. 2017;153:420-429. doi:10.1053/2017.04.022</mixed-citation>
                    </ref>
                                    <ref id="ref5">
                        <label>5</label>
                        <mixed-citation publication-type="journal">Hu Y, Wan JH, Li XY, Zhu Y, Graham DY, Lu NH. Systematic review with metaanalysis: the global recurrence rate of Helicobacter pylori. Aliment Pharmacol Ther. 2017;46(9):773-779. doi:10.1053/j.gastro.2017.04.022</mixed-citation>
                    </ref>
                                    <ref id="ref6">
                        <label>6</label>
                        <mixed-citation publication-type="journal">Suerbaum S, Michetti P. Helicobacter pylori infection. N Engl J Med. 2002;347(15):1175-1186. doi:10.1056/NEJMra020542</mixed-citation>
                    </ref>
                                    <ref id="ref7">
                        <label>7</label>
                        <mixed-citation publication-type="journal">Oluwasola AO, Ola SO, Saliu L, Solanke TF. Helicobacter pylori infection in South Nigerians: a serological study of dyspeptic patients and healthy individuals. West Afr J Med. 2002;21(2):138-141.</mixed-citation>
                    </ref>
                                    <ref id="ref8">
                        <label>8</label>
                        <mixed-citation publication-type="journal">Malfertheiner P, Megraud F, O’Morain C. Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report. Gut. 2007;56(6):772-781. doi:10.1136/gut.2006.101634</mixed-citation>
                    </ref>
                                    <ref id="ref9">
                        <label>9</label>
                        <mixed-citation publication-type="journal">Wyngaarden JB, Lloyd SH Jr, Bennett JC (editors). Cecil Textbook of Medicine. In: Vennes JA. Gastrointestinal endoscopy. 19th Edition, Philedelphia: W. B. Saunders Company. 1992:630634.</mixed-citation>
                    </ref>
                                    <ref id="ref10">
                        <label>10</label>
                        <mixed-citation publication-type="journal">Stigaard T, Meisner S. Novel methods for gastrointestinal endoscopy. Ugeskr Laeger. 2010;172(30):2105-2110.</mixed-citation>
                    </ref>
                                    <ref id="ref11">
                        <label>11</label>
                        <mixed-citation publication-type="journal">Shahid MW, Wallace MB. Endoscopic imaging for the detection of esophageal dysplasia and carcinoma. Gastrointest Endosc Clin N Am. 2010;20(1):11-24. doi:10.1016/j.giec.2009.08.006</mixed-citation>
                    </ref>
                                    <ref id="ref12">
                        <label>12</label>
                        <mixed-citation publication-type="journal">Matos R, Amorim I, Magalhães A, Haesebrouck F, Gärtner F, Reis CA. Adhesion of Helicobacter Species to the Human Gastric Mucosa: A Deep Look Into Glycans Role. Front Mol Biosci. 2021;7(8):656439. doi:10.3389/fmolb.2021.656439</mixed-citation>
                    </ref>
                                    <ref id="ref13">
                        <label>13</label>
                        <mixed-citation publication-type="journal">Raza Y, Khan A, Farooqui A, et al. Oxidative DNA damage as a potential early biomarker of Helicobacter pylori associated carcinogenesis. Pathol Oncol Res. 2014;20(4):839-846. doi:10.1007/s12253-014-9762-1</mixed-citation>
                    </ref>
                                    <ref id="ref14">
                        <label>14</label>
                        <mixed-citation publication-type="journal">Giroux V, Rustgi AK. Metaplasia: Tissue injury adaptation and a precursor to the dysplasia-cancer sequence. Nat Rev Cancer. 2017;17(10):594-604. doi:10.1038/nrc.2017.68</mixed-citation>
                    </ref>
                                    <ref id="ref15">
                        <label>15</label>
                        <mixed-citation publication-type="journal">Slack JM. Metaplasia and transdifferentiation: from pure biology to the clinic. Nat Rev Mol Cell Biol. 2007;8(5):369-378. doi:10.1038/nrm2146</mixed-citation>
                    </ref>
                                    <ref id="ref16">
                        <label>16</label>
                        <mixed-citation publication-type="journal">Li C, Liu Z, Xu G, et al. Aberrant DNA methylation and expression of EYA4 in gastric cardia intestinal metaplasia. Saudi J Gastroenterol. 2022;28(6):456-465. doi:10.4103/sjg.sjg_228_22</mixed-citation>
                    </ref>
                                    <ref id="ref17">
                        <label>17</label>
                        <mixed-citation publication-type="journal">Sharma P, Falk GW, Weston AP, Reker D, Johnston M, Sampliner RE. Dysplasia and cancer in a large multicenter cohort of patients with Barrett&#039;s esophagus. Clin Gastroenterol Hepatol. 2006;4(5):566-572. doi:10.1016/j.cgh.2006.03.001</mixed-citation>
                    </ref>
                                    <ref id="ref18">
                        <label>18</label>
                        <mixed-citation publication-type="journal">Dean E. Anxiety. Nurs Stand. 2016;13.30(46):15. doi:10.7748/ns.30.46.15.s17</mixed-citation>
                    </ref>
                                    <ref id="ref19">
                        <label>19</label>
                        <mixed-citation publication-type="journal">Wolgensinger L. Cognitive behavioral group therapy for anxiety: recent developments. Diyaloglar Clin Neurosci. 2015;17(3):347-351. doi:10.31887/DCNS.2015.17.3/lwolgensinger</mixed-citation>
                    </ref>
                                    <ref id="ref20">
                        <label>20</label>
                        <mixed-citation publication-type="journal">Kafes AY. An overview of depression and anxiety disorders. Humanistic Perspective. 2021;3(1):186-194. doi:10.47793/hp.867111</mixed-citation>
                    </ref>
                                    <ref id="ref21">
                        <label>21</label>
                        <mixed-citation publication-type="journal">Mayer EA, Craske M, Naliboff BD. Depression, anxiety, and the gastrointestinal system. J Clin Psychiatry. 2001;62(8):28-36; discussion 37.</mixed-citation>
                    </ref>
                                    <ref id="ref22">
                        <label>22</label>
                        <mixed-citation publication-type="journal">Norton GR, Norton PJ, Asmundson GJ, Thompson, LA, Larsen DK. Neurotic butterflies in my stomach: the role of anxiety, anxiety sensitivity and depression in functional gastrointestinal disorders. Jf Psychosom Res. 1999;47(3):233-240. doi:10.1016/s0022-3999(99)00032-x</mixed-citation>
                    </ref>
                                    <ref id="ref23">
                        <label>23</label>
                        <mixed-citation publication-type="journal">Lim WY, Subramaniam M, Abdin E, Janhavi Vaingankar J, Ann Chong S. Peptic ulcer disease and mental illnesses. General Hospital Psychiatry. 2014;36(1):63-67. doi:10.1016/j.genhosppsych.2013.09.004</mixed-citation>
                    </ref>
                                    <ref id="ref24">
                        <label>24</label>
                        <mixed-citation publication-type="journal">Babic E, Beyanda M, Karin M, et al. Anxiety, depression and personality types in patients with inflammatory bowel disease: comparison with peptic ulcer and the general population. Psychiatria Danubina. 2021;33(1):48-56. doi:10.24869/psyd.2021.48</mixed-citation>
                    </ref>
                                    <ref id="ref25">
                        <label>25</label>
                        <mixed-citation publication-type="journal">Van Oudenhove L, Vandenberghe J, Demyttenaere K, Tack J. Psychosocial factors, psychiatric illness and functional gastrointestinal disorders: a historical perspective. Digestion. 2010;82(4):201-210. doi:10.1159/000269822</mixed-citation>
                    </ref>
                                    <ref id="ref26">
                        <label>26</label>
                        <mixed-citation publication-type="journal">Addolorato G, Mirijello A, D’Angelo C, et al. State and trait anxiety and depression in patients affected by gastrointestinal diseases: psychometric evaluation of 1641 patients referred to an internal medicine outpatient setting. Int J Clin Pract. 2008;62(7):1063-1069. doi:10.1111/j.1742-1241.2008.01763.x</mixed-citation>
                    </ref>
                                    <ref id="ref27">
                        <label>27</label>
                        <mixed-citation publication-type="journal">Galih FE, Indarwati A, Paramata N, Lumentut Y, Kurniawati SA. The Relationship Between Anxiety Level and Functional Dyspepsia Incidence in Medical Students at State University of Gorontalo. In Proceedings of the 6th International Seminar on Psychology. Purwokerto, Central Java, Indonesia. ISPsy 2023. 2023(7):18-19. doi:10.4108/eai.18-7-2023.2343402</mixed-citation>
                    </ref>
                                    <ref id="ref28">
                        <label>28</label>
                        <mixed-citation publication-type="journal">Aro P, Talley NJ, Ronkainen J, et al. Anxiety is associated with uninvestigated and functional dyspepsia (Rome III criteria) in a Swedish population-based study. Gastroenterology. 2009;137(1):94-100. doi:10.1053/j.gastro.2009.03.039</mixed-citation>
                    </ref>
                                    <ref id="ref29">
                        <label>29</label>
                        <mixed-citation publication-type="journal">Cader J, Domagala Z, Paradowski L, Rymaszewska J, Blonski W, Sajewicz Z. Is there any relation of Helicobacter pylori infection to anxiety and depressive symptoms? Gastroenterologia Polska. 2007;14(6):397.</mixed-citation>
                    </ref>
                                    <ref id="ref30">
                        <label>30</label>
                        <mixed-citation publication-type="journal">Javadi SAHS, Shafikhani AA. Anxiety and depression in patients with gastroesophageal reflux disorder. Electronic Physician. 2017;9(8):5107. doi:10.19082/5107</mixed-citation>
                    </ref>
                                    <ref id="ref31">
                        <label>31</label>
                        <mixed-citation publication-type="journal">Ddine LC, Ddine CC, Rodrigues CCR, Kirsten VR, Colpo E. Factors associated with chronic gastritis in patients with presence and absence of Helicobacter pylori. ABCD: Arq Bras Cir Dig. 2012;25(2):96-100. doi:10.1590/s0102-67202012000200007</mixed-citation>
                    </ref>
                                    <ref id="ref32">
                        <label>32</label>
                        <mixed-citation publication-type="journal">Gezici E, Alpayci M, Özkan Y, Küçük ME, Ünver H, Hız Ö. The effects of helicobacter pylori eradication on the number of tender points, sleep quality, depression, and anxiety in patients with fibromyalgia. Arch Rheumatol. 2014;29(3):151-154. doi:10.5606/ArchRheumatol.2014.3983</mixed-citation>
                    </ref>
                                    <ref id="ref33">
                        <label>33</label>
                        <mixed-citation publication-type="journal">Labban SA, Murshid L, Yousef Alhazmi A, Bafarat AY, Alharbi NM. New-Onset Illness Anxiety Disorder After Helicobacter Pylori Infection: A Case Report. Cureus. 2024;16(1):e52613. doi:10.7759/cureus.52613</mixed-citation>
                    </ref>
                                    <ref id="ref34">
                        <label>34</label>
                        <mixed-citation publication-type="journal">Liou JM, Lee YC, Wu MS. Treatment of Helicobacter pylori infection and its long-term effects on gut microbiota. J Gastroenterol Hepatol. 2020;35(7):1107-1116. doi:10.1111/jgh.14992</mixed-citation>
                    </ref>
                                    <ref id="ref35">
                        <label>35</label>
                        <mixed-citation publication-type="journal">Sun M, Chen H, Dong S, Zhang G, Zhou X, Cheng H. Alteration of gut microbiota in post-stroke depression patients with Helicobacter pylori infection. Neurobiology of Disease. 2024;193:106458. doi:10.1016/j.nbd.2024.106458</mixed-citation>
                    </ref>
                                    <ref id="ref36">
                        <label>36</label>
                        <mixed-citation publication-type="journal">Kabeer KK, Ananthakrishnan N, Anand C, Balasundaram S. Prevalence of Helicobacter Pylori Infection and Stress, Anxiety or Depression in Functional Dyspepsia and Outcome after Appropriate Intervention. JCDR. 2017;11(8):11-15. doi:10.7860/JCDR/2017/26745.10486</mixed-citation>
                    </ref>
                                    <ref id="ref37">
                        <label>37</label>
                        <mixed-citation publication-type="journal">Moayyedi P, Dixon MF. Significance of Helicobacter pylori infection and gastric cancer: implications for screening. Gastrointestl Endosc Clin N Am. 1997;7(1):47-64.</mixed-citation>
                    </ref>
                                    <ref id="ref38">
                        <label>38</label>
                        <mixed-citation publication-type="journal">Jiang JX, Liu Q, Zhao B, et al. Risk factors for intestinal metaplasia in a southeastern Chinese population: an analysis of 28,745 cases. J Cancer Res Clin Oncol 2017;143(3):409-418. doi:10.1007/s00432-016-2299-9</mixed-citation>
                    </ref>
                                    <ref id="ref39">
                        <label>39</label>
                        <mixed-citation publication-type="journal">Tian J, Wang Z, Ren Y, et al. Rapamycin Attenuates Anxiety and Depressive Behavior Induced by Helicobacter pylori in Association with Reduced Circulating Levels of Ghrelin. Neural Plasticity. 2022;1:2847672. doi:10.1155/2022/2847672</mixed-citation>
                    </ref>
                                    <ref id="ref40">
                        <label>40</label>
                        <mixed-citation publication-type="journal">Agawa S, Futagami S, Yamawaki H, et al. Acylated ghrelin levels were associated with depressive status, physical quality of life, endoscopic findings based on Kyoto classification in Japan. J Clin Biochem Nutr. 2019;65(1):65-70. doi:10.3164/jcbn.18-111</mixed-citation>
                    </ref>
                                    <ref id="ref41">
                        <label>41</label>
                        <mixed-citation publication-type="journal">Al Quraan AM, Beriwal N, Sangay P, Namgyal T. The Psychotic Impact of Helicobacter pylori Gastritis and Functional Dyspepsia on Depression: A Systematic Review. Cureus. 2019;11(10):e5956. doi:10.7759/cureus.5956</mixed-citation>
                    </ref>
                                    <ref id="ref42">
                        <label>42</label>
                        <mixed-citation publication-type="journal">Kivrak Y, Kokacya H, Copoglu US, et al. Does Helicobacter Pylori cause pyschiatric symptoms in dyspeptic patients? Acta Medica. 2014;30:1271-1277.</mixed-citation>
                    </ref>
                                    <ref id="ref43">
                        <label>43</label>
                        <mixed-citation publication-type="journal">Wu Y, Fan Y, Jiang Y, Wang Y, Liu H, Wei M. Analysis of risk factors associated with precancerous lesion of gastric cancer in patients in eastern China: a comparative study. Journal of Cancer Research and Therapeutics. 2013;9(2):205-209. doi:10.4103/0973-1482.113351</mixed-citation>
                    </ref>
                                    <ref id="ref44">
                        <label>44</label>
                        <mixed-citation publication-type="journal">Ma SR, Ma Q, Hao CQ, et al. Zhonghua yu fang yi xue za zhi. Chinese Journal of Preventive Medicine. 2017;51(8):670-674. doi:10.3760/cma.j.issn.0253-9624.2017.08.003</mixed-citation>
                    </ref>
                                    <ref id="ref45">
                        <label>45</label>
                        <mixed-citation publication-type="journal">Ahmadi Soleimani SM, Masoudi M, Tabrizi AMA, et al. Regulatory effects of probiotics on anxiety and depression-like behaviors in H. pylori-Infected rats. Probiotics and Antimicrobial Proteins. 2025:1-15. doi:10.1007/s12602-025-10674-4</mixed-citation>
                    </ref>
                            </ref-list>
                    </back>
    </article>
