Refractory iron deficiency anaemia due to silent H. pylori gastritis in children

Aglaia Kyriakou Children's Hospital, Athínai, Attica, Greece
European Journal of Pediatrics (Impact Factor: 1.89). 04/2003; 162(3):177-9. DOI: 10.1007/s00431-002-1139-x
Source: PubMed


We describe the cases of three children with chronic active Helicobacter pylori gastritis and iron-deficiency anaemia without evidence of oesophagogastrointestinal bleeding. In all cases, long-standing iron supplementation became effective only after eradication of Helicobacter pylori. CONCLUSION: Iron-deficiency anaemia may be due to clinically inapparent H. pylori gastritis.

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    • "However, bleeding lesions are rarely observed under the endoscopic examination, and fecal occult blood tests are usually negative. This does not support the conclusion that chronic bleeding is the cause of H. pylori-related iron deficiency anemia [20], [21], [22], [23], [24]. (2) Atrophic gastritis induced by H. pylori reduces HCl secretion and interferes with iron absorption. "
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    ABSTRACT: Iron deficiency anemia is an extra-stomach disease experienced in H. pylori carriers. Individuals with type A blood are more prone to suffering from H. pylori infection than other individuals. To clarify the molecular mechanisms underlying H. pylori-associated anemia, we collected erythrocytes from A, B, O, and AB blood donors and analyzed morphology, the number of erythrocytes with H. pylori colonies attached to them, and iron contents in erythrocytes and H. pylori (NCTC11637 and SS1 strains) by means of optical microscopy, scanning electron microscopy, and synchrotron radiation soft X-ray imaging. The number of type A erythrocytes with H. pylori attached to them was significantly higher than that of other erythrocytes (P<0.05). Far more iron distribution was observed in H. pylori bacteria using dual energy analysis near the iron L2, 3 edges by soft X-ray imaging. Iron content was significantly reduced in host erythrocytes after 4 hours of exposure to H. pylori. H. pylori are able to adhere more strongly to type A erythrocytes, and this is related to iron shift from the host to the bacteria. This may explain the reasons for refractory iron deficiency anemia and elevated susceptibility to H. pylori infection in individuals with type A blood.
    PLoS ONE 11/2012; 7(11):e50314. DOI:10.1371/journal.pone.0050314 · 3.23 Impact Factor
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    • "However, the degree of systemic inflammatory response associated with H. pylori infection has not been evaluated. Gastrointestinal blood loss associated with H. pylori infection as a cause of anaemia, as reported in one study (Kostaki et al. 2003), has not been confirmed (Sarker et al. 2004). "
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    ABSTRACT: We evaluated the adverse effect of asymptomatic Helicobacter pylori infection in children on the response to Fe supplementation. One hundred and sixty-nine children aged 1-10 years from the urban poor community underwent a [13C]urea breath test for H. pylori and haematological tests at admission and after 8 weeks. Both H. pylori-positive and -negative children were randomly assigned to receive ferrous fumarate syrup (20 mg elemental Fe twice daily) or placebo for 8 weeks and a single dose of vitamin A (33,000 microg). Admission findings were compared between H. pylori-positive and -negative children. Response to Fe was compared between Fe-supplemented H. pylori-positive and -negative children. Seventy-nine per cent of the children were aged 1-5 years and half of them were boys. In eighty-five H. pylori-positive and eighty-four H. pylori-negative children, the differences in mean Hb (112 (sd 12.6) v. 113 (sd 12.0) g/l), haematocrit (34 (sd 3.5) v. 35 (sd 3.2) %) and ferritin (23.8 v. 21.0 microg/l) were similar. After 8 weeks of Fe supplementation, mean Hb was 5.3 g/l more (95 % CI 1.59, 9.0) and haematocrit was 1.4 % more (95 % CI 0.2, 2.6) in H. pylori-negative (n 44) compared with H. pylori-positive (n 42) children. Mean ferritin was similar at admission and improved in both H. pylori-positive and -negative children. Asymptomatic H. pylori infection was not associated with higher rates of anaemia or Fe deficiency in children, but had a significant adverse effect on response to Fe therapy. However, this result is based on exploratory analysis and needs confirmation.
    British Journal Of Nutrition 05/2006; 94(6):969-75. DOI:10.1079/BJN20061816 · 3.45 Impact Factor
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    ABSTRACT: A high prevalence and early colonization of Helicobacter pylori infection in childhood was described again this year in developing countries in contrast to developed ones. Upper gastrointestinal endoscopy including gastric biopsies remains the diagnostic gold standard method for this infection. Also noninvasive tests have been studied in children, including serology, 13C-urea breath test and stool antigen test, showing good results in the different age groups as compared to the gold standard. However, the infection often remains asymptomatic in children and the role of this bacterium in gastric manifestations is the subject of conflicting reports. Extra-digestive manifestations are also reported in the course of this infection. The treatment of H. pylori infection is influenced by resistance of the bacteria to the antibiotics used. We suggest that eradication of H. pylori should take place only after susceptibility testing. The association of a proton pump inhibitor and two antibiotics for 1 or 2 weeks gives the best eradication rates. The crucial question to elucidate is whether asymptomatic children should be treated to prevent cancer in the future.
    Helicobacter 02/2003; 8 Suppl 1(s1):61-7. DOI:10.1046/j.1523-5378.2003.00165.x · 4.11 Impact Factor
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