Role of Helicobacter pylori in refractory iron deficiency anaemia

Abstract

The role of Helicobacter pylori infection in the development of iron deficiency anaemia has been the focus of attention over the past decade. However, confirmation of a relationship has not confirmed the pathophysiological mechanisms involved in the phenomenon. The aim of the present work is to study the levels of fasting gastric acidity (free and total) as well as the level of tumour necrosis factor-alpha (TNF alpha) in male refractory iron deficiency anaemia patients seropositive for H. pylori infection versus those who are seronegative. Thirty adult patients with iron deficiency anaemia and gastroduodenitis were subdivided into two groups of matched age and haemoglobin value. Group 1 was H. pylori-seropositive for infection and these patients did not receive prior treatment for eradication of H. pylori infection. Group 2 comprised patients seronegative for H. pylori infection (control group). Patients with active bleeding or previous medical problems were excluded from the study. All patients and controls were subjected to the following at presentation: history taking and thorough clinical examination, complete blood picture, reticulocytes (%), assessment of serum iron, total iron binding capacity, serum ferritin, IgG anti-Helicobacter antibody and TNF alpha, stool for occult blood and measurement of gastric acidity (total and free). Upper endoscopy was performed and multiple biopsies were taken and tested for expression of cytotoxin-associated gene A (cagA) by the polymerase chain reaction (PCR). Results showed significantly higher values of free and total gastric acidity as well as TNF alpha levels in Group 1 compared to controls (Group 2). Among those in Group 1, higher TNF alpha levels were seen in seven H. pylori cagA-positive patients than in eight cagA-negative patients. Haemoglobin values were inversely correlated with TNF alpha levels. Thus, elevated serum TNF alpha in the H. pylori-seropositive group may be one of the underlying pathophysiological mechanism for iron deficiency anaemia observed in these patients.

Helicobacter pyloriand extragastric diseases: A review

“…Inorganic iron dissolves best in a highly acidic environment, and H. pylori infection may reduce the bioavailability of dietary iron. Patients infected with CagA-positive strains and those with refractory IDA have high serum levels of TNFα, which is a pro-inflammatory cytokine that can induce anemia[ 80 , 81 ]. Hershko et al[ 82 ] demonstrated that 64%-75% of patients with IDA and H. pylori infections had a complete disappearance of IDA after H. pylori eradication.…”

Role of Helicobacter Pylori Virulence Factors for Iron Acquisition from Gastric Epithelial Cells of the Host and Impact on Bacterial Colonization

“…H. pylori eradication is recommended in infected patients with unexplained IDA [1]. However, pathogenesis of H. pylori-associated IDA is multifactorial, also linked to reduced gastric acid secretion (low iron uptake/solubilization), diminished gastric juice ascorbic acid, autoimmunity, iron sequestration of lactoferrin or elevated serum TNF-a level [9,12].…”

Higher Prevalence of Non-thyroidal-Illness Syndrome in Elderly Male Patients With Active Helicobacter pylori Infection

“…A significant association ( P = 0.041) between active H. pylori infection and anemia was identified at the beginning of the study, which corroborated our previous findings ( 37 ). While there is an inverse relationship between TNF-α and hemoglobin ( 38 ), this also adds consideration to the hypothesis that inflammation in H. pylori may cause the initial rise of TNF-α, which itself may potentially lead to anemia. As anemia is a marker of inflammation that may result as part of an adaptive response as is the case in NTIS, it is possible to establish a plausible link between H. pylori , anemia and NTIS.…”