Pre-endoscopic screening for Helicobacter pylori and celiac disease in young anemic women

To evaluate the usefulness of pre-endoscopic serological screening for Helicobacter pylori (H pylori) infection and celiac disease in women aged < 50 years affected by iron-deficiency anemia (IDA).

One hundred and fifteen women aged < 50 years with IDA were tested by human recombinant tissue transglutaminase IgA antibodies (tTG) and anti-H pylori IgG antibodies. tTG and H pylori IgG antibody were assessed using an enzyme-linked immunosorbent assay (ELISA). All women were invited to undergo upper GI endoscopy. During gastroscopy, biopsies were collected from antrum (n = 3), gastric body (n = 3) and duodenum (n = 4) in all patients, irrespective of test results. The assessment of gastritis was performed according to the Sydney system and celiac disease was classified by Marsh's System.

45.2% women were test-positive: 41 patients positive for H pylori antibodies, 9 patients for tTG and 2 patients for both. The gastroscopy compliance rate of test-positive women was significantly increased with respect to those test-negative (65.4% vs 42.8%; Fisher test P = 0.0239). The serological results were confirmed by gastroscopy in 100% of those with positive H pylori antibodies, in 50% of those with positive tTG and in 81.5% of test-negative patient. Sensitivity and specificity were 84.8% and 100%, respectively for H pylori infection and, 80% and 92.8% for tTG. Twenty-eight patients had positive H pylori antibodies and in all the patients, an active H pylori infection was found. In particular, in 23 out of 28 (82%) patients with positive H pylori antibodies, a likely cause of IDA was found because of the active inflammation involving the gastric body.

Anti-H pylori IgG antibody and tTG IgA antibody testing is able to select women with IDA to submit for gastroscopy to identify H pylori pangastritis and/or celiac disease, likely causes of IDA.