Serum-soluble transferrin receptor concentrations in Helicobacter pylori-associated iron-deficiency anemia

Study of Serum Ferritin, Zinc, and Copper Levels in Children With Helicobacter pylori Gastritis and the Effect of the Treatment

OBJECTIVES

This study aimed to assess serum iron, zinc, and copper in symptomatic children with Helicobacter pylori infection, to correlate their serum levels with the degree of gastritis, and to evaluate the effect of H. pylori treatment on their levels.

METHODS

This study was carried out on 70 children with upper gastrointestinal tract symptoms. H. pylori infection was diagnosed by the H. pylori antigen test in the stool and histopathologic findings during upper gastrointestinal endoscopy. Patients were divided into 2 groups; H. pylori -positive and H. pylori -negative groups. Hemoglobin, serum ferritin, transferrin (sTfR), zinc, and copper were assessed in all included children.

RESULTS

The hemoglobin level, serum ferritin, and zinc were significantly lower in H. pylori -positive patients compared to H. pylori -negative patients. However, the serum copper level was comparable between the 2 groups. After treatment, the hemoglobin level, serum ferritin, and serum zinc significantly increased in H. pylori -positive patients, especially in those who responded to treatment compared to their levels before treatment. There was a significant negative correlation between the severity of histopathologic abnormalities and hemoglobin level, serum ferritin, and zinc levels, but a significant positive relation with sTfR concentrations in H. pylori -positive patients.

CONCLUSIONS

H. pylori -infected children had low serum ferritin and zinc levels but high sTfR level with no effect on serum copper levels. After treatment, hemoglobin, serum ferritin, and zinc levels significantly improved in H. pylori -positive patients. Gastric histologic findings correlated significantly with hemoglobin, serum ferritin, zinc, and sTfR levels.

The Association between Helicobacter Pylori Infection and Iron Deficiency Anemia in Children: A Systematic Review and Meta-Analysis

Objectives This study, comprising a systematic review and meta-analysis, was conducted to assess the association between Helicobacter pylori infection and the risk of iron deficiency anemia (IDA) in children.

Methods We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Relevant published studies were searched in the databases. Retrieved studies were assessed for quality using the Modified Newcastle-Ottawa Scale for quality assessment. The “meta” package of statistical software “R 4.0.3 was used for statistical analysis.

Results Overall, 22 eligible studies (eight cross-sectional, six randomized control trials, five case-control, two surveys, and one cohort), including nine (40.9%) from Asia, four (18.1%) from America, four (18.1%) from Africa, four (18.1%) from Europe, and one (4.5%) from Australia with a total of 3,434 cases and 4,455 controls were included in this systematic review and meta-analysis. We found that H. pylori infection was associated with a high risk of IDA (odds ratio 1.70, 95% confidence interval 1.21 − 2.38) in a random-effects model. Meta-regression analysis showed that none of the investigated factors that may affect the prevalence of IDA reached statistical significance. There was statistically significant difference between results when studies were categorized according to the methods used to diagnose H. pylori and level of incomes based on World Bank classification. The GRADEpro Guideline Development Tool evidence for the risk of IDA was of a “moderate certainty.”

Conclusions This meta-analysis with a “moderate certainty” of evidence showed an association between H. pylori infection and a high risk of developing IDA in children.

Iron status determination in individuals with Helicobacter pylori infection: conventional vs. new laboratory biomarkers

Background Helicobacter pylori has been associated with iron deficiency (ID). This study is aimed at investigating ID with conventional (ferritin, transferrin saturation [TSAT]) and new biomarkers (soluble transferrin receptor [sTfR], sTfR/log ferritin, reticulocyte hemoglobin content [CHr], hepcidin-25) in patients sub-grouped by the presence or absence of H. pylori infection. Methods In total, 200 consecutive outpatients, who were referred for the H. pylori 13C-urea breath test (13C-UBT), underwent blood testing for ID. Additionally, Thomas-plot (TP)-analyses (sTfR/log ferritin, CHr) were calculated. Results Fifty-three and 147 individuals were found with and without H. pylori infection, respectively. Patients with H. pylori infection showed a higher sTfR concentration (p<0.02) and a higher sTfR/log ferritin ratio (p<0.05). Based on a ferritin <30 μg/L and/or a TSAT <20%, 25/53 (47.2%) patients with H. pylori infection and 63/147 (42.9%) without H. pylori infection showed ID. Based on TP-analyses, 10/53 (18.9%) patients with and 17/147 (11.6%) without H. pylori infection were identified with ID. Completed eradication therapy tended to be associated with functional ID. Conclusions Helicobacter pylori infection was associated with significantly higher plasma sTfR concentrations and sTfR/log ferritin ratios. Patients with H. pylori eradication therapy were more often detected with functional ID compared to patients without eradication therapy, when using the new biomarkers.

An updated systematic review and meta-analysis on the association between Helicobacter pylori infection and iron deficiency anemia

BACKGROUND

We conducted an updated systematic review and meta-analysis to examine the prevalence of depleted iron stores among persons infected with Helicobacter pylori compared to uninfected ones. We also assessed the impact of anti-H. pylori eradication therapy plus iron therapy on ferritin and hemoglobin levels compared to iron therapy alone.

METHODS

A literature search was conducted using the databases Medline, the Cochrane Library, Cochrane Central Register of Controlled Trials, EMBASE, and the Science Citation Index Expanded. Observational studies with methodological quality score of 13 (median score) and above, on a scale of 0-16, and all randomized controlled trials (RCTs) were eligible for the meta-analyses. Pooled point estimates and 95% confidence intervals (CI) were obtained using the random effects model.

RESULTS

Compared to uninfected persons, H. pylori-infected individuals showed increased likelihood of iron deficiency anemia (14 observational studies); pooled OR 1.72 (95% CI 1.23-2.42); iron deficiency (pooled OR 1.33; 95% CI 1.15-1.54; 30 studies); and anemia (pooled OR 1.15; 95% CI 1.00-1.32; 23 studies). Meta-analyses of seven RCTs showed increased ferritin, standardized mean difference (SMD) 0.53 (95% 0.21-0.85), but not hemoglobin, SMD 0.36 (95% -0.07 to 0.78), Pv=.1, following anti-H. pylori eradication therapy plus iron therapy as compared with iron therapy alone. Significant heterogeneity was found among studies, as well as evidence of publication bias.

CONCLUSIONS

Current evidence indicates increased likelihood of depleted iron stores in relation to H. pylori infection. H. pylori eradication therapy, added to iron therapy, might be beneficial in increasing ferritin and hemoglobin levels.

Survey of anaemia and Helicobacter pylori infection in adolescent girls in Suihua, China and enhancement of iron intervention effects by H. pylori eradication

In the present study, we investigated the prevalence of anaemia and Fe deficiency anaemia (IDA) and explored the relationship between Helicobacter pylori infection and IDA in adolescent girls. A total of 1037 adolescent girls from Suihua, China were enrolled. Hb, serum ferritin (SF), serum transferrin receptor (sTfR) and serum IgG antibodies to H. pylori were measured. Participants with IDA and co-existing H. pylori infection (n 80) who had an intake of >25 mg/d of Fe were assigned randomly to the intervention and control groups. Patients in the intervention group were administered a 12-week course of oral EDTA-Na-Fe (60 mg Fe/dose, three times a week) and a 2-week course of colloidal bismuth subcitrate, amoxicillin and metronidazole. Subjects in the control group were administered EDTA-Na-Fe alone. Hb, SF and sTfR were reassessed 3 months after the 12-week regimen ended. Prevalence of anaemia, Fe deficiency (defined as SF < 12·0 μg/l), IDA and H. pylori infection in the population of 1037 was 19.5, 40.4, 17.1 and 31.2 %, respectively. The prevalence of H. pylori infection in the IDA group was 46.9 %, while the non-anaemic group had 28.1 % prevalence. A significant increase in Hb and SF and a decrease in sTfR value were found in the intervention group and the H. pylori-negative group. Findings suggest that IDA is still one of the prominent problems in adolescent girls. There is an association between H. pylori infection and IDA. Treatment of H. pylori infection is associated with a more rapid response to oral Fe therapy.

Anemia and its impact on function in nursing home residents: what do we know?

PURPOSE

To provide the advanced practice nurse (APN) information on the prevalence and causes of anemia in elderly nursing home (NH) residents, in order to affect diagnostic and management strategies that may help improve physical function and mobility outcomes.

DATA SOURCES

Literature review of current peer-reviewed research articles.

CONCLUSIONS

In the United States, the prevalence of anemia increases with advancing age, and are reported to be much higher among older NH residents than among community-dwelling older adults. Causes of anemia among the elderly are often multifactorial. Older individuals with anemia, including mild anemia and even low normal level, have demonstrated lower muscle strength, physical function, mobility, and increased morbidity and mortality outcomes.

IMPLICATIONS FOR PRACTICE

Given the potentially significant relationship between anemia and physical performance outcomes among NH residents, gaining a better understanding will help guide future evidence-based care by allowing the APN an opportunity to tailor both medical and restorative care interventions. Because anemia is a potentially modifiable condition, intervention may preserve, limit, or reverse functional impairment and/or disablement, and allow for maximal functional independence.

Extragastric manifestations of Helicobacter pylori infection -- other Helicobacters

Today there is evidence that Helicobacter pylori has a critical role in different extragastric diseases. The discovery of a number of other novel Helicobacter species has stimulated the research in different extragastric diseases, in which an infectious hypothesis is plausible. Enterohepatic Helicobacter species have been hypothesized to play a role in different disorders, including hepatocellular carcinoma, gallstones formation and cholangiocellular carcinoma, as well as enteric diseases and inflammatory bowel diseases. Concerning the extragastric manifestations of H. pylori infection, idiopathic thrombocytopenic purpura, and sideropenic anemia represent, based on the current data, the diseases in which the pathogenic link appears to be strongest. There is also an increasing evidence for a possible association of H. pylori with cardiovascular disease.