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

Abstract

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.

Review:Helicobacter pyloriand extragastric diseases

“…Demerdash et al, who enrolled 105 IDA patients and 70 age‐ and gender‐matched controls, clearly demonstrated a higher prevalence of H pylori infection in refractory IDA patients (61.5%) and a positive correlation with the mean corpuscular value (MCV; P = .046). Moreover, they observed a significant correlation between administration of anti‐ H pylori treatment plus iron and improvement of hemoglobin ( P < .001), MCV ( P < .001), iron ( P < .001), and ferritin levels ( P < .001) . Mwafy et al investigated 150 H pylori ‐positive patients (18‐50 years old) and 150 matched controls for several hematologic parameters, and they found significantly lower levels of iron in infected patients compared to uninfected (71.6 ± 24.8 vs 80.1 ± 20.7 μg/dL) and similar results were obtained for vitamin B12 levels (262.5 ± 100 vs 378.2 ± 160.6 pg/mL) .…”

Common Pitfalls in the Management of Patients with Micronutrient Deficiency: Keep in Mind the Stomach

“…More recently, other authors worldwide reported the association between Helicobacter pylori infection and iron deficiency anemia. A recent study conducted in Mexico found a 7.8% prevalence of Helicobacter pylori infection in iron deficiency anemia patients referred to an academic hematology center [ 43 ], while an Egyptian study showed a higher prevalence of Helicobacter pylori infection in refractory iron deficiency anemia (61.5%) and a significant correlation between administration of anti- Helicobacter pylori treatment plus iron and improvement in terms of hemoglobin, mean corpuscular volume, iron, and ferritin levels [ 44 ]. A recent systematic review and meta-analysis showed that compared to uninfected subjects, Helicobacter pylori -infected individuals showed an increased likelihood of iron deficiency anemia (OR 1.72; 95% CI 1.23–2.42); and iron deficiency (OR 1.33; 95% CI 1.15–1.54), reporting increased ferritin levels following anti- Helicobacter pylori eradication therapy plus iron therapy as compared with iron therapy alone [ 45 ].…”

Treatment of Helicobacter pylori in the Arab world: a systematic review and network meta-analysis

“…Our sample consisted of a total of 7,829 patients, including both genders aged between 2 and 75 years. Studies from Egypt (n=18) [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] , Saudi Arabia (n=8) [46][47][48][49][50][51][52][53] , Lebanon (n=6) [54][55][56][57][58][59] , UAE (n=5) [60][61][62][63][64] , Iraq (n=3) [65][66][67] , Qatar (n=3) [68][69][70] , Algeria (n=2) 71,72 , Palestine (n=1) 73 , Morocco (n=1) 74 , Syria (n=1) 75 , Yemen (n=1) 76 Tunisia (n=1) 77…”