The impact of Helicobacter pylori infection on iron status and gastric mucosa in adult patients with refractory iron deficiency anemia

Background and objectives: Iron deficiency is one of the most common nutritional problems of human race. Helicobacter pylori (Hp) infection is the main known cause of gastritis, gastroduodenal ulcer and gastric cancer. The study was designed to evaluate the role of Hp infection in refractory iron deficiency anemia (rIDA) in adults, and to determine whether Hp eradication is an effective therapeutic strategy to improve iron status and gastric mucosal pathology in these patients. Methods: The study included 53 adults with rIDA and active gastric Hp infection. Following standard workup for rIDA, patients were offered triple therapy for Hp eradication then oral iron therapy for 2 months. Reassessment of iron status was performed twice; at 3 and 6 months after initiation of iron therapy. Endoscopy, histopathological and immunohistochemical assessments were repeated in the second follow up visit. Results: In all studied patients, Hp eradication was effective and the rIDA patients achieved normal hemoglobin levels (mean; 12.52 gm/dl), transferrin saturation (mean; 30.62%), and serum ferritin (mean; 47.59 ng/ml) three months following iron therapy with significantly higher levels as compared to pre-treatment values (p<0.001). At the 6 months' follow up visit, minimal non significant improvement of the iron status was noted with no relapse after termination of oral iron therapy. Hp induced gastritis (58.5%), gastric epithelial metaplasia (18.9%) and dysplasia (22.6%) in the studied patients. Hp eradication resulted in histological improvement in 83.9% of cases with gastritis, 60% of cases with metaplasia and 83.3% of dysplasia cases. Conclusion: The study proved a significant role of Hp infection in the pathogenesis of rIDA and the impairment of gastric mucosa in the form of gastritis, metaplasia or dysplasia. Hp eradication improves iron status with partial improvement of gastric mucosal lesions. Screening for Hp infection and its early treatment are recommended in patients with rIDA to treat anemia and improve gastric mucosal lesions. [Nahla A. Nosair, Atef M. Taha, Sherif E Ezzat and Dareen A. Mohamed. The impact of Helicobacter pylori infection on iron status and gastric mucosa in adult patients with refractory iron deficiency anemia. Life Sci J 2014;11(10):1290-1297]. (ISSN:1097-8135). http://www.lifesciencesite.com. 190