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Helicobacter pylori and iron deficiency anaemia in children
M Ashorn1, T Ruuska, A Mäkipernaa
1Dept. of Pediatrics, Tampere University Hospital, Finland. merja.ashorn@uta.fi
Insights
Helicobacter pylori (H. pylori) infection may cause severe iron deficiency anaemia in children. Eradicating H. pylori improved anemia, suggesting H. pylori screening for children with unexplained anemia.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Hematology
Background:
- Iron deficiency anaemia (IDA) and Helicobacter pylori (H. pylori) infection are uncommon in developed nations.
- A potential link between IDA and H. pylori infection has been proposed.
- This study investigated the clinical presentation and treatment outcomes in H. pylori-colonized children with severe anemia.
Purpose of the Study:
- To define the clinical characteristics of H. pylori infection in children with severe iron deficiency anaemia.
- To evaluate the efficacy of H. pylori eradication therapy on anemia correction in this pediatric population.
Main Methods:
- Eight children with iron deficiency anaemia refractory to iron therapy underwent gastroscopy for suspected H. pylori.
- H. pylori eradication was attempted using combination therapies (bismuth/metronidazole or omeprazole/clarithromycin/amoxicillin).
- Treatment efficacy was confirmed via urea breath test; anemia response was assessed by hemoglobin levels.
Main Results:
- H. pylori infection and chronic active gastritis were confirmed in all eight children.
- Successful eradication of H. pylori was achieved in 7 out of 8 patients.
- Post-treatment, hemoglobin levels improved, although iron stores remained deficient in 4 children.
Conclusions:
- H. pylori infection appears to play a role in the pathogenesis of iron deficiency anaemia in school-aged children.
- Screening for H. pylori should be considered in children presenting with iron deficiency anaemia, even without gastrointestinal symptoms.
- Bacterial eradication can lead to hematological improvement in anemic children with H. pylori infection.
Background:
Both iron deficiency anaemia and Helicobacter pylori infection are rare in developed countries. A possible connection has been suggested between these two diseases and our aim was to define the clinical picture and to study the effect of bacterial eradication in H. pylori colonized children with severe anaemia.
Methods:
Eight children with iron deficiency anaemia refractory to iron supplementation were examined with gastroscopy because of suspicion of H. pylori infection. Anaemia was treated with oral ferrous sulphate. Two patients needed blood transfusions. Eradication therapy was given either with combination of colloidal bismuth subcitrate and metronidazole or with omeprazole, clarithromycin and amoxycillin. Eradication was confirmed by urea breath test 4 weeks post-treatment.
Results:
H. pylori infection was confirmed histologically and microbiologically in all children, who also presented with chronic, active gastritis. Bacteria were successfully eradicated in 7/8 patients. Correction of haemoglobin values was observed post-treatment, iron stores still being deficient at control in 4/8 children.
Conclusions:
Our results suggest that H. pylori might have a role in causing iron deficiency anaemia in school-age children. Screening for H. pylori should be extended to cover those patients with other clinical manifestations than symptoms from gastrointestinal tract.