Helicobacter pylori-associated hypochlorhydria in children, and development of iron deficiency
Paul R Harris1, Carolina A Serrano, Andrea Villagrán
1Division of Paediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
Insights
Childhood Helicobacter pylori infection combined with hypochlorhydria (low stomach acid) is linked to iron deficiency. This suggests a dual role in iron homeostasis, particularly in high-prevalence areas.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Nutritional Science
Background:
- Helicobacter pylori infection can cause hypochlorhydria, a condition of low stomach acid.
- Hypochlorhydria may impair iron absorption, contributing to iron deficiency (ID).
- The relationship between H. pylori-associated hypochlorhydria and ID in children requires further investigation.
Purpose of the Study:
- To assess the association between H. pylori-associated hypochlorhydria and iron deficiency in symptomatic children.
- To determine if H. pylori infection and hypochlorhydria act together to influence iron status.
Main Methods:
- Prospective enrollment of 123 symptomatic children.
- Collection of blood, gastric juice, and biopsies for analysis of iron parameters, H. pylori status, and gastric pH.
- Exclusion of children with celiac disease or parasitic infections.
Main Results:
- Ten children presented with hypochlorhydria (pH>4).
- H. pylori-positive children with hypochlorhydria showed significantly lower serum iron and transferrin saturation compared to H. pylori-positive children without hypochlorhydria.
- No significant differences in iron parameters were observed in H. pylori-negative children with hypochlorhydria.
Conclusions:
- Low serum iron and transferrin saturation in children with H. pylori infection are associated with hypochlorhydria.
- The combination of H. pylori infection and hypochlorhydria plays a role in the etiology of iron deficiency in children.
- Transient hypochlorhydria from H. pylori gastritis can disrupt iron homeostasis, with clinical relevance in high-prevalence regions.
Aims:
Acute Helicobacter pylori infection is associated with transient hypochlorhydria. In H pylori-associated atrophy, hypochlorhydria has a role in iron deficiency (ID) through changes in the physiology of iron-complex absorption. The aims were to evaluate the association between H pylori-associated hypochlorhydria and ID in children.
Methods:
Symptomatic children (n=123) were prospectively enrolled. Blood, gastric juice and gastric biopsies were taken, respectively, for haematological analyses, pH assessment and H pylori determination, and duodenal biopsies for exclusion of coeliac disease. Stool samples were collected for parasitology/microbiology. Thirteen children were excluded following parasitology and duodenal histopathology, and five due to impaired blood analysis.
Results:
Ten children were hypochlorhydric (pH>4) and 33 were H pylori positive. In H pylori-positive children with pH>4 (n=6) serum iron and transferrin saturation levels % were significantly lower (p<0.01) than H pylori-positive children with pH≤4. No differences in ferritin, or total iron binding capacity, were observed. In H pylori-negative children with pH>4, iron and transferrin saturation were not significantly different from children with pH≤4.
Conclusions:
Low serum iron and transferrin in childhood H pylori infection is associated with hypochlorhydria. In uninfected children, hypochlorhydria was not associated with altered serum iron parameters, indicating a combination of H pylori infection and/or inflammation, and hypochlorhydria has a role in the aetiology of ID. Although H pylori-associated hypochlorhydria is transient during acute gastritis, this alters iron homeostasis with clinical impact in developing countries with a high H pylori prevalence.
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