Published online Jul 14, 2013. doi: 10.3748/wjg.v19.i26.4166
Revised: April 16, 2013
Accepted: June 1, 2013
Published online: July 14, 2013
AIM: To assess the aetiological role of Helicobacter pylori (H. pylori) infection in adult patients with iron-refractory or iron-dependent anaemia of previously unknown origin.
METHODS: Consecutive patients with chronic iron-deficient anaemia (IDA) with H. pylori infection and a negative standard work-up were prospectively evaluated. All of them had either iron refractoriness or iron dependency. Response to H. pylori eradication was assessed at 6 and 12 mo from follow-up. H. pylori infection was considered to be the cause of the anaemia when a complete anaemia resolution without iron supplements was observed after eradication.
RESULTS: H. pylori was eradicated in 88 of the 89 patients. In the non-eradicated patient the four eradicating regimens failed. There were violations of protocol in 4 patients, for whom it was not possible to ascertain the cause of the anaemia. Thus, 84 H. pylori eradicated patients (10 men; 74 women) were available to assess the effect of eradication on IDA. H. pylori infection was considered to be the aetiology of IDA in 32 patients (38.1%; 95%CI: 28.4%-48.8%). This was more frequent in men/postmenopausal women than in premenopausal women (75% vs 23.3%; P < 0.0001) with an OR of 9.8 (95%CI: 3.3-29.6). In these patients, anaemia resolution occurred in the first follow-up visit at 6 mo, and no anaemia or iron deficiency relapse was observed after a mean follow-up of 21 ± 2 mo.
CONCLUSION: Gastric H. pylori infection is a frequent cause of iron-refractory or iron-dependent anaemia of previously unknown origin in adult patients.
Core tip: Data on the effect of Helicobacter pylori (H. pylori) eradication on adult patients with iron-refractory or iron-dependent anaemia of previously unknown origin are scarce, and thus the frequency of H. pylori infection as the cause of anaemia in that setting is unknown. Resolution of iron-deficient anaemia (IDA) was observed in 32 out of the 84 H. pylori eradicated patients (38.1%). In all of them there was no relapse after a mean follow-up of 21 ± 2 mo. Thus, H. pylori infection was considered the aetiology of IDA in these cases. H. pylori infection as the aetiology of IDA was greater in men plus postmenopausal women than in premenopausal women (75.0% vs 23.3%, P < 0.0001).