1
|
Esposito G, Dottori L, Pivetta G, Ligato I, Dilaghi E, Lahner E. Pernicious Anemia: The Hematological Presentation of a Multifaceted Disorder Caused by Cobalamin Deficiency. Nutrients 2022; 14:nu14081672. [PMID: 35458234 PMCID: PMC9030741 DOI: 10.3390/nu14081672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/08/2022] [Accepted: 04/14/2022] [Indexed: 02/04/2023] Open
Abstract
Pernicious anemia is still a neglected disorder in many medical contexts and is underdiagnosed in many patients. Pernicious anemia is linked to but different from autoimmune gastritis. Pernicious anemia occurs in a later stage of autoimmune atrophic gastritis when gastric intrinsic factor deficiency and consequent vitamin B12 deficiency may occur. The multifaceted nature of pernicious anemia is related to the important role of cobalamin, which, when deficient, may lead to several dysfunctions, and thus, the proteiform clinical presentations of pernicious anemia. Indeed, pernicious anemia may lead to potentially serious long-term complications related to micronutrient deficiencies and their consequences and the development of gastric cancer and type 1 gastric neuroendocrine tumors. When not recognized in a timely manner or when pernicious anemia is diagnosed with delay, these complications may be potentially life-threatening and sometimes irreversible. The current review aimed to focus on epidemiology, pathogenesis, and clinical presentations of pernicious anemia in an attempt to look beyond borders of medical specialties. It aimed to focus on micronutrient deficiencies besides the well-known vitamin B12 deficiency, the diagnostic approach for pernicious anemia, its long-term complications and optimal clinical management, and endoscopic surveillance of patients with pernicious anemia.
Collapse
|
2
|
Carabotti M, Annibale B, Lahner E. Common Pitfalls in the Management of Patients with Micronutrient Deficiency: Keep in Mind the Stomach. Nutrients 2021; 13:nu13010208. [PMID: 33450823 PMCID: PMC7828248 DOI: 10.3390/nu13010208] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 12/31/2020] [Accepted: 01/08/2021] [Indexed: 02/05/2023] Open
Abstract
Micronutrient deficiencies are relatively common, in particular iron and cobalamin deficiency, and may potentially lead to life-threatening clinical consequences when not promptly recognized and treated, especially in elderly patients. The stomach plays an important role in the homeostasis of some important hematopoietic micronutrients like iron and cobalamin, and probably in others equally important such as ascorbic acid, calcium, and magnesium. A key role is played by the corpus oxyntic mucosa composed of parietal cells whose main function is gastric acid secretion and intrinsic factor production. Gastric acid secretion is necessary for the digestion and absorption of cobalamin and the absorption of iron, calcium, and probably magnesium, and is also essential for the absorption, secretion, and activation of ascorbic acid. Several pathological conditions such as Helicobacter pylori-related gastritis, corpus atrophic gastritis, as well as antisecretory drugs, and gastric surgery may interfere with the normal functioning of gastric oxyntic mucosa and micronutrients homeostasis. Investigation of the stomach by gastroscopy plus biopsies should always be considered in the management of patients with micronutrient deficiencies. The current review focuses on the physiological and pathophysiological aspects of gastric acid secretion and the role of the stomach in iron, cobalamin, calcium, and magnesium deficiency and ascorbate homeostasis.
Collapse
|
3
|
Fisher L, Fisher A, Smith PN. Helicobacter pylori Related Diseases and Osteoporotic Fractures (Narrative Review). J Clin Med 2020; 9:E3253. [PMID: 33053671 PMCID: PMC7600664 DOI: 10.3390/jcm9103253] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/28/2020] [Accepted: 10/07/2020] [Indexed: 02/06/2023] Open
Abstract
Osteoporosis (OP) and osteoporotic fractures (OFs) are common multifactorial and heterogenic disorders of increasing incidence. Helicobacter pylori (H.p.) colonizes the stomach approximately in half of the world's population, causes gastroduodenal diseases and is prevalent in numerous extra-digestive diseases known to be associated with OP/OF. The studies regarding relationship between H.p. infection (HPI) and OP/OFs are inconsistent. The current review summarizes the relevant literature on the potential role of HPI in OP, falls and OFs and highlights the reasons for controversies in the publications. In the first section, after a brief overview of HPI biological features, we analyze the studies evaluating the association of HPI and bone status. The second part includes data on the prevalence of OP/OFs in HPI-induced gastroduodenal diseases (peptic ulcer, chronic/atrophic gastritis and cancer) and the effects of acid-suppressive drugs. In the next section, we discuss the possible contribution of HPI-associated extra-digestive diseases and medications to OP/OF, focusing on conditions affecting both bone homeostasis and predisposing to falls. In the last section, we describe clinical implications of accumulated data on HPI as a co-factor of OP/OF and present a feasible five-step algorithm for OP/OF risk assessment and management in regard to HPI, emphasizing the importance of an integrative (but differentiated) holistic approach. Increased awareness about the consequences of HPI linked to OP/OF can aid early detection and management. Further research on the HPI-OP/OF relationship is needed to close current knowledge gaps and improve clinical management of both OP/OF and HPI-related disorders.
Collapse
Affiliation(s)
- Leon Fisher
- Department of Gastroenterology, Frankston Hospital, Peninsula Health, Melbourne 3199, Australia
| | - Alexander Fisher
- Department of Geriatric Medicine, The Canberra Hospital, ACT Health, Canberra 2605, Australia;
- Department of Orthopedic Surgery, The Canberra Hospital, ACT Health, Canberra 2605, Australia;
- Australian National University Medical School, Canberra 2605, Australia
| | - Paul N Smith
- Department of Orthopedic Surgery, The Canberra Hospital, ACT Health, Canberra 2605, Australia;
- Australian National University Medical School, Canberra 2605, Australia
| |
Collapse
|
4
|
Deficiency of micronutrients in patients affected by chronic atrophic autoimmune gastritis: A single-institution observational study. Dig Liver Dis 2019; 51:505-509. [PMID: 30236765 DOI: 10.1016/j.dld.2018.08.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 08/23/2018] [Accepted: 08/27/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Chronic atrophic autoimmune gastritis (CAAG) leads to vitamin B12 deficiency, but other micronutrient deficiencies are largely understudied. AIMS To investigate the prevalence of micronutrient deficiencies in CAAG patients and their potential relationship with the grading of gastric atrophy or entero-chromaffin-like cells hyperplasia or body mass index (BMI). METHODS From 2005 to 2016 a number of CAAG patients underwent regular follow-up with annual blood testing and upper gastrointestinal tract endoscopy every years. RESULTS Out of the 122 CAAG patients checked (100 F; median age 65 years), 76 presented nutritional deficiencies, single in 24 and multiple in 52 cases: a deficiency of B12 and iron showed in 42 patients, 25-OH vitamin D lacked in 76 and folic acid in 6 cases. 25-OH vitamin D levels directly correlated with B12 levels and were significantly lower in patients with macronodular than in those with linear or micronodular hyperplasia. No significant correlation was observed between B12, folic acid or ferritin levels and BMI, blood gastrin levels, the grading of gastric atrophy or ECL cells hyperplasia. CONCLUSIONS 25-OH vitamin D deficiency was the main one in CAAG patients: its correlation with B12 deficiency may indicate underlying shared pathogenic mechanisms, although further studies are needed to confirm this hypothesis.
Collapse
|
5
|
Cavalcoli F, Zilli A, Conte D, Massironi S. Micronutrient deficiencies in patients with chronic atrophic autoimmune gastritis: A review. World J Gastroenterol 2017; 23:563-572. [PMID: 28216963 PMCID: PMC5292330 DOI: 10.3748/wjg.v23.i4.563] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 10/08/2016] [Accepted: 11/13/2016] [Indexed: 02/06/2023] Open
Abstract
Chronic atrophic autoimmune gastritis (CAAG) is an organ-specific autoimmune disease characterized by an immune response, which is directed towards the parietal cells and intrinsic factor of the gastric body and fundus and leads to hypochlorhydria, hypergastrinemia and inadequate production of the intrinsic factor. As a result, the stomach’s secretion of essential substances, such as hydrochloric acid and intrinsic factor, is reduced, leading to digestive impairments. The most common is vitamin B12 deficiency, which results in a megaloblastic anemia and iron malabsorption, leading to iron deficiency anemia. However, in the last years the deficiency of several other vitamins and micronutrients, such as vitamin C, vitamin D, folic acid and calcium, has been increasingly described in patients with CAAG. In addition the occurrence of multiple vitamin deficiencies may lead to severe hematological, neurological and skeletal manifestations in CAAG patients and highlights the importance of an integrated evaluation of these patients. Nevertheless, the nutritional deficiencies in CAAG are largely understudied. We have investigated the frequency and associated features of nutritional deficiencies in CAAG in order to focus on any deficit that may be clinically significant, but relatively easy to correct. This descriptive review updates and summarizes the literature on different nutrient deficiencies in CAAG in order to optimize the treatment and the follow-up of patients affected with CAAG.
Collapse
|
6
|
The role of hepcidin, ferroportin, HCP1, and DMT1 protein in iron absorption in the human digestive tract. GASTROENTEROLOGY REVIEW 2014; 9:208-13. [PMID: 25276251 PMCID: PMC4178046 DOI: 10.5114/pg.2014.45102] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 07/02/2012] [Accepted: 11/25/2012] [Indexed: 12/21/2022]
Abstract
Iron is found in almost all foods, so dietary iron intake is related to energy intake. However, its availability for absorption is quite variable, and poor bioavailability is a major reason for the high prevalence of nutritional iron deficiency anaemia. Absorption occurs primarily in the proximal small intestine through mature enterocytes located at the tips of the duodenal villi. Two transporters: Hem Carrier Protein 1 (HCP1) and Divalent Metal Transporter 1 (DMT1) appear to mediate the entry of most if not all dietary iron into these mucosal cells. Absorption is regulated according to the body's needs. The results of studies suggest that iron absorption is regulated by the control of iron export from duodenal enterocytes to the circulating transferrin pool by ferroportin. Hepcidin, a 25-amino acid polypeptide, which is synthesised primarily in hepatocytes, reduces the iron absorption from the intestine by binding to the only known cellular iron exporter, ferroportin, causing it to be degraded. Therefore, hepcidin is now considered to be the most important factor controlling iron absorption.
Collapse
|
7
|
Wong F, Rayner-Hartley E, Byrne MF. Extraintestinal manifestations of Helicobacter pylori: A concise review. World J Gastroenterol 2014; 20:11950-11961. [PMID: 25232230 PMCID: PMC4161781 DOI: 10.3748/wjg.v20.i34.11950] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 01/28/2014] [Accepted: 05/05/2014] [Indexed: 02/06/2023] Open
Abstract
Helicobacter pylori (H. pylori) infection has been clearly linked to peptic ulcer disease and some gastrointestinal malignancies. Increasing evidence demonstrates possible associations to disease states in other organ systems, known as the extraintestinal manifestations of H. pylori. Different conditions associated with H. pylori infection include those from hematologic, cardiopulmonary, metabolic, neurologic, and dermatologic systems. The aim of this article is to provide a concise review of the evidence that supports or refutes the associations of H. pylori and its proposed extraintestinal manifestations. Based on data from the literature, PUD, mucosal associated lymphoid tumors lymphoma, and gastric adenocarcinoma has well-established links. Current evidence most supports extraintestinal manifestations with H. pylori in immune thrombocytopenic purpura, iron deficiency anemia, urticaria, Parkinson’s, migraines and rosacea; however, there is still plausible link with other diseases that requires further research.
Collapse
|
8
|
Alvarenga EC, Montes CG, Guerrazzi F, Zeitune JM, Grotto HZW. Helicobacter pylori infection and the severity of gastritis are not associated with iron deficiency in a group of Brazilian patients. Clin Chem Lab Med 2010; 48:1809-12. [PMID: 20961199 DOI: 10.1515/cclm.2010.356] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Helicobacter pylori (H. pylori) infection has been associated with iron deficiency anemia. However, results reported in the literature are contradictory. The goal of the present study was to study the possible association between H. pylori infection and iron deficiency in a sample of adults. METHODS One hundred and fifty individuals were studied (H. pylori-positive n=75; H. pylori-negative n=50). The presence of anemia was determined using red cell indices and reticulocyte hemoglobin content (CHr). Iron status was assessed based on serum iron and ferritin levels. Possible involvement of inflammatory activity in erythropoiesis was investigated by measuring the correlation between C-reactive protein (CRP) and red cell indices and iron status. RESULTS There were no significant differences in the hematological or biochemical parameters for the two groups. Iron deficiency was diagnosed in six individuals, but no difference in prevalence was found between the H. pylori-positive and H. pylori-negative groups. A weak but significant inverse correlation was observed between CRP and CHr concentrations and between serum gastrin and CHr in the H. pylori-positive group. These results suggest a reduction in iron availability for reticulocyte hemoglobinization, but insufficient to cause anemia. CONCLUSIONS H. pylori infection was not a determining factor for development of iron deficiency in our study population.
Collapse
Affiliation(s)
- Eliana C Alvarenga
- Department of Clinical Pathology, Faculty of Medical Sciences, State University of Campinas, Brazil
| | | | | | | | | |
Collapse
|
9
|
Haghi-Ashtiani MT, Monajemzadeh M, Motamed F, Mahjoub F, Sharifan M, Shahsiah R, Kashef N. Anemia in Children with and without Helicobacter pylori Infection. Arch Med Res 2008; 39:536-40. [DOI: 10.1016/j.arcmed.2008.04.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2008] [Accepted: 04/07/2008] [Indexed: 12/30/2022]
|
10
|
Ferguson C, Dickey W. Gastrointestinal investigation of iron deficiency anaemia detected by pre-blood donation screening. Scand J Gastroenterol 2007; 42:1386-7. [PMID: 17852843 DOI: 10.1080/00365520701408847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Charles Ferguson
- Department of Gastroenterology, Altnagelvin Hospital, Londonderry, Northern Ireland
| | | |
Collapse
|
11
|
DiGirolamo AM, Perry GS, Gold BD, Parkinson A, Provost EM, Parvanta I, Grummer-Strawn LM. Helicobacter pylori, anemia, and iron deficiency: relationships explored among Alaska native children. Pediatr Infect Dis J 2007; 26:927-34. [PMID: 17901799 DOI: 10.1097/inf.0b013e31812e52cd] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Attempts to understand determinants of anemia and iron deficiency have led researchers to examine the role of Helicobacter pylori infection. The current study assessed determinants of anemia and iron deficiency, including H. pylori, in Alaska Native children. METHODS In 1999, a population-based survey was conducted among 86 children (67% response rate), mean age of 43.7 months (standard deviation = 16.8 months). Samples of breath, stool, and venous blood were obtained from children for measures of anemia, iron deficiency, H. pylori, fecal blood loss, and current inflammation. Standardized interviews with parents provided information on demographics, illness, and intake of dietary iron, iron-absorption inhibitors, and enhancers. RESULTS Of the 86 children studied, 17.4% were anemic and 38.6% were iron deficient. Forty-one percent of the cohort had H. pylori-specific IgG antibodies, 86% tested positive by the urea breath test (UBT), and 80% tested positive by the stool antigen test. Presence of H. pylori antibodies emerged as a significant risk factor for anemia and iron deficiency in adjusted analyses controlling for demographic factors, current inflammation, and antibiotic use. In contrast, children with positive UBT or stool antigen results were significantly less likely to have anemia or iron deficiency than those with negative results. CONCLUSIONS Results from different measures of H. pylori may reflect different stages of infection. Relationships between H. pylori and anemia/iron deficiency may depend on the phase of infection measured, with serologic tests reflecting established H. pylori infection associated with anemia/iron deficiency, and UBT and stool antigen results reflecting an earlier stage of infection.
Collapse
Affiliation(s)
- Ann M DiGirolamo
- Hubert Department of Global Health, Emory University, Atlanta, GA 30322, USA.
| | | | | | | | | | | | | |
Collapse
|
12
|
Sarraf Z, Goldberg D, Shahbazi M, Arbuckle K, Salehi M. Nutritional status of schoolchildren in rural Iran. Br J Nutr 2007; 94:390-6. [PMID: 16176610 DOI: 10.1079/bjn20051487] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The present study compared the nutritional status of schoolchildren from recently settled, ethnic minority tribespeople with those from a Persian village in southern Iran. Height and weight were measured and blood was collected from school children at three time points over 1·5 years. Supplemental Fe was provided to children with low Hb after the first screening. Twenty-one per cent of the children were wasted, 57 % were stunted and 23 % were anaemic. No statistically significant difference in the prevalence of wasting, stunting and anaemia was found between gender or ethnic groups. Children over the age of 12 years had a higher prevalence of wasting than children aged below 12 years. In a sub-sample of forty-one children the average BMI-for-age decreased. Fe supplementation increased Hb levels to normal in most children, but did not increase Fe level in a few children. Dietary deficiency of micronutrients, especially Zn and Fe, probably accounts for the high prevalence of stunting and anaemia in these children. Infection withHelicobacter pyloriis another possible explanation for the Fe-deficiency anaemia. Further investigation is in progress to determine the cause(s) of the observed deficiencies.
Collapse
Affiliation(s)
- Zahra Sarraf
- Shiraz University of Medical Sciences, Shiraz, Iran
| | | | | | | | | |
Collapse
|
13
|
Lagarde S, Jovenin N, Diebold MD, Jaussaud R, Cahn V, Bertin E, Jolly D, Thiéfin G, Cadiot G. Is there any relationship between pernicious anemia and iron deficiency? ACTA ACUST UNITED AC 2007; 30:1245-9. [PMID: 17185966 DOI: 10.1016/s0399-8320(06)73532-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Previous studies have suggested that iron deficiency could be due to atrophic gastritis of the body/fundus. The aim of this study was to determine the prevalence of iron deficiency among patients with pernicious anemia and associated factors. PATIENTS AND METHODS All patients with pernicious anemia diagnosed at our institution between January 1990 and February 2005 were included. Inclusion criteria were: 1- histological diagnosis of atrophic fundic gastritis and 2- criteria of gastric autoimmune involvement. Histology of gastric biopsies was performed in a blinded manner. Iron deficiency was defined as serum ferritin level<15 microg/L in women and<40 microg/L in men. RESULTS Ninety-five patients (69 women), mean age 60 years (range: 23-90) were included. Twenty patients (21.1%) had normal blood cell counts; 12 patients (12.6%) had microcytosis with or without anemia and 53 patients (55.8%) macrocytosis with or without anemia. Serum ferritin levels were measured in 58 patients, 16 (27.6%) of whom, all women, had iron deficiency. They were significantly younger (39.2 years) than patients without iron deficiency (61.6 years, P<0.0001). Serum gastrin levels did not differ between the groups with and without iron deficiency. A significantly more severe inflammatory infiltrate of the fundus and endocrine cell hyperplasia was observed in iron deficiency patients. Multivariate analysis showed that iron deficiency was linked to female gender and age<50 years. CONCLUSION Iron deficiency and microcytic anemia are not rare in patients with pernicious anemia and should not rule out the diagnosis. Iron deficiency does not appear to be related to the degree of atrophic fundic gastritis but is linked to female gender and young age, suggesting menstrual blood loss could play a role. Whether decreased iron absorption due to reduced acid secretion favors the expression of gynecological iron loss cannot be ascertained.
Collapse
Affiliation(s)
- Stéphanie Lagarde
- Service d'Hépato-Gastro-Entérologie, CHU Robert Debré, Avenue du Général Koenig, 51092 Reims Cedex.
| | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Shan Y, Lambrecht RW, Bonkovsky HL. Association of hepatitis C virus infection with serum iron status: analysis of data from the third National Health and Nutrition Examination Survey. Clin Infect Dis 2005; 40:834-41. [PMID: 15736017 DOI: 10.1086/428062] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2004] [Accepted: 11/10/2004] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND There is growing evidence that mildly increased amounts of iron in the liver can increase hepatic injury, particularly if combined with other hepatotoxic factors, such as alcohol use, use of porphyrogenic drugs, or chronic viral hepatitis. In the present study, the association of hepatitis C virus (HCV) infection with serum measurements of iron status was assessed in the US population. METHODS We analyzed data from a total of 14,462 participants in the Third National Health and Nutrition Examination Survey. We excluded subjects who were aged <12 years, subjects for whom measurements of serum levels of iron or ferritin or the results of liver function tests were missing, and subjects who had a serum transferrin saturation of > or =50% (to help exclude subjects with hemochromatosis). RESULTS Mean serum levels of ferritin and iron (+/- standard error) were significantly higher among subjects with HCV infection (100+/-3 ng/mL and 229+/-17 microg/dL, respectively) than among subjects without liver disease (83+/-0.3 ng/mL and 101+/-2.1 microg/dL, respectively) (P<.0001). Serum levels of ferritin were directly and significantly correlated with serum levels of alanine aminotransferase, aspartate aminotransferase, and gamma-glutamyl transpeptidase (r=0.25, r=0.24, and r=0.28, respectively; P<.0001), whereas platelet counts were inversely correlated with serum levels of ferritin (r=-0.12; P<.0001). CONCLUSION HCV infection is significantly associated with higher serum levels of ferritin and iron in the US population.
Collapse
Affiliation(s)
- Ying Shan
- Department of Medicine, University of Connecticut Health Center, Farmington, CT 06030, USA.
| | | | | |
Collapse
|
15
|
Casella G, Villanacci V, Perego D, Somma A, Monti C, Baldini V. Autoimmune gastritis and HCV chronic hepatitis: a possible association in presence of mild iron deficiency anemia. J Clin Gastroenterol 2004; 38:832. [PMID: 15365420 DOI: 10.1097/01.mcg.0000139054.20544.ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
|
16
|
Ciacci C, Sabbatini F, Cavallaro R, Castiglione F, Di Bella S, Iovino P, Palumbo A, Tortora R, Amoruso D, Mazzacca G. Helicobacter pylori impairs iron absorption in infected individuals. Dig Liver Dis 2004; 36:455-60. [PMID: 15285524 DOI: 10.1016/j.dld.2004.02.008] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Infection with Helicobacter pylori is recognised as a major risk factor for chronic gastritis, peptic ulcer disease and gastric cancer. The association between H. pylori infection and iron deficiency anaemia has been established. Multiple mechanisms have been advocated to explain the relationship between H. pylori and iron status and their association might reduce iron deposit. AIM Aim of this study was to investigate whether H. pylori infection affects iron absorption. METHODS The study was designed on a prospective basis. Fifty-five subjects underwent upper gastrointestinal endoscopy and biopsy to investigate the presence of H. pylori and, when this was positive, also search of serum anti-CagA was performed. Tests included an oral iron absorption test with the administration of 1 mg/kg of Fe2+. Iron levels were measured before and 2 h after iron administration (delta iron). H. pylori-positive subjects were administered antibiotic therapy for 1 week and, 2 months later, the oral iron absorption test was repeated and urea-breath test was first performed. RESULTS H. pylori-positive subjects had lower serum level of ferritin and lower delta iron compared to H. pylori-negative subjects. That difference is significant in anaemic women and is independent of the presence of serum anti-CagA antibodies. After H. pylori eradication iron absorption test was similar to those of non-infected subjects. CONCLUSION H. pylori infection impairs iron uptake. That mechanism, together with others, may contribute to the depletion of iron in infected patients.
Collapse
Affiliation(s)
- C Ciacci
- Department of Clinical and Experimental Medicine, Gastrointestinal Unit, Federico II University of Naples, via Pansini 5, 80131 Naples, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Abstract
Iron deficiency anaemia is generally considered a sign of occult bleeding from the gastrointestinal tract, and standard care therefore includes evaluation of the gastrointestinal tract to rule out possible bleeding sites. However, it is often overlooked that iron deficiency anaemia may be the result of an imbalance between iron loss and iron intake, and may also be due to reduced absorption of iron from food, i.e., coeliac disease. The absorption of alimentary iron is not a simple process and the stomach plays a major role in this process of iron "digestion". This review presents evidence linking iron deficiency anaemia to gastric conditions that lead to reduced acid secretion, such as, for example, gastric surgery, atrophic body gastritis and Helicobacter pylori gastritis.
Collapse
Affiliation(s)
- B Annibale
- Department of Digestive and Liver Disease, II Medical School, Sant'Andrea Hospital, University La Sapienza, Rome, Italy.
| | | | | |
Collapse
|