<i>Helicobacter pylori</i> and Iron‐deficiency Anemia in Adolescents in Brazil

Araf, Litza Neves; Pereira, Carlos Alberto de Bragança; Machado, Rodrigo Strehl; Raguza, Daniele; Kawakami, Elisabete

doi:10.1097/mpg.0b013e3181d40cd7

Cited by 19 publications

(21 citation statements)

References 27 publications

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confidence: 67%

“…A subsequent meta-analysis of existing studies detected an association between H. pylori infection and IDA, based on analyses of hemoglobin and serum ferritin levels (16). Conversely, several other studies have not detected any association between H. pylori and anemia (14,15,18).Animal studies examining a potential link between H. pylori infection and anemia have also yielded conflicting results (19-22). In one study, H. pylori-infected male INS-GAS mice (which overexpress gastrin) exhibited reductions in both hemoglobin and serum ferritin levels compared to uninfected animals; however, the mean corpuscular volume (MCV; a measure of the average size of erythrocytes) was elevated in the infected cohort (21), a finding that differs from the reduced MCV typically observed in patients with IDA.…”

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confidence: 71%

“…Anemia often occurs in the setting of symptomatic H. pylori-associated diseases (peptic ulcer disease or gastric cancer), but it has been suggested that H. pylori may also be a cause of IDA in asymptomatic persons with no evidence of peptic ulcer disease or gastric cancer (9). H. pylori has been linked to several other hematologic diseases, including pernicious anemia (vitamin B 12 deficiency arising through an autoimmune-mediated process) and idiopathic thrombocytopenic purpura (ITP; a disorder characterized by a reduction in circulating platelets) (10-12).Human epidemiologic studies examining a potential association between H. pylori colonization and anemia have yielded conflicting results (13)(14)(15)(16)(17)(18). In one of the largest studies to date, serum ferritin and hemoglobin levels were analyzed in 2,794 Dutch adults to determine if H. pylori infection was associated with IDA.…”

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confidence: 99%

“…Human epidemiologic studies examining a potential association between H. pylori colonization and anemia have yielded conflicting results (13)(14)(15)(16)(17)(18). In one of the largest studies to date, serum ferritin and hemoglobin levels were analyzed in 2,794 Dutch adults to determine if H. pylori infection was associated with IDA.…”

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Dietary Composition Influences Incidence of Helicobacter pylori-Induced Iron Deficiency Anemia and Gastric Ulceration

et al. 2016

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Epidemiologic studies have provided conflicting data regarding an association between Helicobacter pylori infection and iron deficiency anemia (IDA) in humans. Here, a Mongolian gerbil model was used to investigate a potential role of H. pylori infection, as well as a possible role of diet, in H. pylori-associated IDA. Mongolian gerbils (either H. pylori infected or uninfected) received a normal diet or one of three diets associated with increased H. pylori virulence: high-salt, low-iron, or a combination of a high-salt and low-iron diet. In an analysis of all infected animals compared to uninfected animals (independent of diet), H. pylori-infected gerbils had significantly lower hemoglobin values than their uninfected counterparts at 16 weeks postinfection (P < 0.0001). The mean corpuscular volume (MCV) and serum ferritin values were significantly lower in H. pylori-infected gerbils than in uninfected gerbils, consistent with IDA. Leukocytosis and thrombocytosis were also detected in infected gerbils, indicating the presence of a systemic inflammatory response. In comparison to uninfected gerbils, H. pylori-infected gerbils had a higher gastric pH, a higher incidence of gastric ulcers, and a higher incidence of fecal occult blood loss. Anemia was associated with the presence of gastric ulceration but not gastric cancer. Infected gerbils consuming diets with a high salt content developed gastric ulcers significantly more frequently than gerbils consuming a normal-salt diet, and the lowest hemoglobin levels were in infected gerbils consuming a high-salt/low-iron diet. These data indicate that H. pylori infection can cause IDA and that the composition of the diet influences the incidence and severity of H. pylori-induced IDA.A nemia affects up to 1.6 billion people worldwide, potentially resulting in fatigue, decreased productivity, increased susceptibility to infection, or death (1-5). A wide variety of infectious processes can be primary causes of anemia or can exacerbate anemia arising from noninfectious etiologies. For example, intestinal parasitic infections can cause chronic blood loss, leading to iron deficiency anemia (IDA; i.e., anemia due to iron deficiency) (3, 6). Anemia arises in patients with malaria because the parasites invade erythrocytes (2), and bacterial toxins can cause hemolysis (7). In addition, chronic infections, chronic immune activation, and cancer can cause a form of anemia known as "anemia of chronic disease" (8).Colonization of the human stomach with the gastric bacterium Helicobacter pylori is another potential cause of anemia. Anemia often occurs in the setting of symptomatic H. pylori-associated diseases (peptic ulcer disease or gastric cancer), but it has been suggested that H. pylori may also be a cause of IDA in asymptomatic persons with no evidence of peptic ulcer disease or gastric cancer (9). H. pylori has been linked to several other hematologic diseases, including pernicious anemia (vitamin B 12 deficiency arising through an autoimmune-mediated process) and idiopathic throm...

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confidence: 71%

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Dietary Composition Influences Incidence of Helicobacter pylori-Induced Iron Deficiency Anemia and Gastric Ulceration

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“…5 Furthermore, lower prevalence was found among adolescents (10-16 years of age) in a public school in the city of São Paulo (40.7%). 11 It is clear that this urban indigenous community presented higher prevalence of this infection. The age group at highest risk of contracting the infection was the group younger than three years of age.…”

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confidence: 99%

Prevalência de infecção por Helicobacter pylori em uma comunidade indígena em São Paulo e fatores associados: estudo transversal

et al. 2017

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CONTEXT AND OBJECTIVE: The prevalence of Helicobacter pylori infection is unevenly distributed among different populations. The aim here was to evaluate the factors associated with Helicobacter pylori infection among children up to five years of age living in a high-risk community. DESIGN AND SETTING: Cross-sectional study in an indigenous community of Guarani Mbya ethnicity, Tekoa Ytu and Tekoa Pyau villages, Jaraguá district, city of São Paulo (SP), Brazil. METHODS: 74 children aged 0.4 to 4.9 years (mean 2.9 ± 1.3 years; median 3.1), and 145 family members (86 siblings, 43 mothers and 16 fathers) were evaluated for Helicobacter pylori infection using the validated 13 C-urea breath test. Clinical and demographic data were collected. RESULTS: The prevalence was 8.3% among children aged 1-2 years and reached 64.3% among those aged 4-5 years (P = 0.018; overall 31.1%). The prevalence was 76.7% among siblings and 89.8% among parents. There was a negative association with previous use of antibiotics in multivariate analysis adjusted for age (odds ratio, OR: 0.07; 95% confidence interval, CI: 0.01 to 0.66; P = 0.02). The prevalence was higher among males (OR: 1.55), and was associated with maternal infection (OR: 1.81), infection of both parents (OR: 1.5), vomiting (OR: 1.28), intestinal parasitosis (OR: 2.25), previous hospitalization (OR: 0.69) and breastfeeding (OR: 1.87). CONCLUSIONS: The prevalence was high among subjects older than three years of age, thus suggesting that the incidence of infection was higher over the first three years of life. Previous use of antibiotics was inversely associated with current Helicobacter pylori infection. RESUMOCONTEXTO E OBJETIVO: A prevalência da infecção pelo Helicobacter pylori é desigualmente distribuída entre diferentes populações. O objetivo foi avaliar fatores associados à infecção pelo Helicobacter pylori em crianças de até cinco anos de idade morando numa comunidade de alto risco. TIPO DE ESTUDO E LOCAL: Estudo transversal na comunidade indígena da etnia Guarani Mbya das aldeias Tekoa Ytu e Tekoa Pyau do distrito de Jaraguá da cidade de São Paulo (SP), Brasil. MÉTODOS: 74 crianças de 0,4 a 4,9 anos (média 2,9 ± 1,3 anos; mediana 3,1), e 145 familiares (86 irmãos, 43 mães e 16 pais) foram avaliadas quanto à infecção pelo Helicobacter pylori com o teste respiratório com ureia 13 C validado. Dados clínicos e demográficos foram coletados. RESULTADOS: Prevalência foi 8,3% entre 1-2 anos, atingindo 64,3% entre 4-5 anos (P = 0,018; 31,1% globalmente). Em irmãos, foi 76,7% e 89,8% nos pais. Observou-se associação negativa com uso prévio de antibiótico em análise multivariada ajustada para idade (odds ratio, OR: 0,07; intervalo de confiança, IC: 95%: 0,01-0,66; P = 0,02). A prevalência foi maior no sexo masculino (OR: 1,55), e foi associada a infecção materna (OR: 1,81), infecção de ambos os pais (OR: 1,5), vômitos (OR: 1,28), parasitose intestinal (OR: 2,25), hospitalização prévia (OR: 0,69) e aleitamento materno (OR: 1,87). CONCLUSÕES: A prevalência foi alta entre ...

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Helicobacter pylori associated to unexplained or refractory iron deficiency anemia: an Egyptian single-center experience

Demerdash

Ibrahim

Hassan

et al. 2018

Hematology, Transfusion and Cell Therapy

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BackgroundRefractory or unexplained iron deficiency anemia accounts for about 15% of all cases. The endoscopic gastrointestinal workup sometimes fails to establish the cause of iron deficiency anemia and a considerable proportion of patients regardless of risk category fail to respond to oral iron supplementation. The aim of the present study was to assess the etiological role of Helicobacter pylori infection in adult Egyptian patients with unexplained or refractory iron deficiency anemia.MethodsA case controlled study was composed of 104 iron deficiency anemia cases and 70 age- and gender-matched healthy controls. Patients were diagnosed with iron deficiency anemia according to hemoglobin, mean corpuscular volume, serum ferritin, and transferrin saturation. Upper and lower endoscopies were performed and active H. pylori infection was investigated by testing for the H. pylori antigen in stool specimens. Hematological response to H. pylori treatment with triple therapy together with iron therapy (n = 32) or only iron therapy (n = 32) were assessed in patients with H. pylori infection.ResultsH. pylori infection was more prevalent in patients with unexplained or refractory iron deficiency anemia (61.5%). Of the different hematological parameters investigated, there was a significant correlation only between H. pylori infection and mean corpuscular volume (p-value 0.046). Moreover, there was a significant correlation between receiving triple therapy together with iron supplementation and improvements in the hematological parameters [hemoglobin (p-value < 0.001), mean corpuscular volume (p-value < 0.001), iron (p-value < 0.001) and serum ferritin (p-value < 0.001)] compared to receiving iron supplementation alone.ConclusionsFailing to test for H. pylori infection could lead to a failure to identify a treatable cause of anemia and could lead to additional and potentially unnecessary investigations. Furthermore, treatment of H. pylori infection together with iron supplementation gives a more rapid and satisfactory response.

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Helicobacter pylori and Iron‐deficiency Anemia in Adolescents in Brazil

Abstract: The study was not able to find a relation between H pylori infection and ID or anemia.

Cited by 19 publications

References 27 publications

Dietary Composition Influences Incidence of Helicobacter pylori-Induced Iron Deficiency Anemia and Gastric Ulceration

Dietary Composition Influences Incidence of Helicobacter pylori-Induced Iron Deficiency Anemia and Gastric Ulceration

Prevalência de infecção por Helicobacter pylori em uma comunidade indígena em São Paulo e fatores associados: estudo transversal

Helicobacter pylori associated to unexplained or refractory iron deficiency anemia: an Egyptian single-center experience

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