Effect of Helicobacter pylori infection and low-dose aspirin use on iron stores in the elderly

The Link between Iron Turnover and Pharmacotherapy in Transplant Patients

Iron is a transition metal that plays a crucial role in several physiological processes. It can also exhibit toxic effects on cells, due to its role in the formation of free radicals. Iron deficiency and anemia, as well as iron overload, are the result of impaired iron metabolism, in which a number of proteins, such as hepcidin, hemojuvelin and transferrin, take part. Iron deficiency is common in individuals with renal and cardiac transplants, while iron overload is more common in patients with hepatic transplantation. The current knowledge about iron metabolism in lung graft recipients and donors is limited. The problem is even more complex when we consider the fact that iron metabolism may be also driven by certain drugs used by graft recipients and donors. In this work, we overview the available literature reports on iron turnover in the human body, with particular emphasis on transplant patients, and we also attempt to assess the drugs’ impact on iron metabolism, which may be useful in perioperative treatment in transplantology.

Relationship between active Helicobacter pylori infection and anemia, iron deficiency, iron deficiency anemia: A cross‐sectional study in a sub‐Saharan setting

Background and Aim

There have been contradictory reports about the association between Helicobacter pylori infection and iron deficiency anemia (IDA). Based on the high frequency of H. pylori infection in Cameroon, we have evaluated the frequency of H. pylori infection as the cause of anemia, and IDA among dyspeptic patients in Cameroon.

Methods

This cross‐sectional study enrolled 842 dyspeptic patients (472 women and 370 men) in two reference hospitals in Douala‐Cameroon. Each participant gave a written consent, and the study was approved by the National Ethical Committee. Erythroid‐related indices and markers of iron deficiency (ID) measurement were done for each participant as well as H. pylori detection. Data were analyzed using SSPS statistical package.

Results

The prevalence of anemia, ID, IDA, and H. pylori infection was 65.08%, 31.47%, 25.65%, and 80.88%, respectively. H. pylori infected individuals had a significantly lower mean value of hemoglobin (P = 0.01), hematocrit (P = 0.04), ferritin (P = 0.03) and coefficient of transferrin saturation (CTS) levels (P = 0.04) and a significantly higher mean value of mean corpuscular hemoglobin concentration (MCHC) (P = 0.02). Compared with H. pylori non‐infected participants, H. pylori infected patients were 1.2938 (95% confidence interval [CI]: 0.9087–1.8421), 1.1851 (95% CI: 0.8122–1.7292), and 1.5636 (95% CI: 1.0206–2.3953) times at higher risk to develop anemia, ID, and IDA, respectively. A significant relationship was found between H. pylori infection and IDA (P = 0.04 and 0.04 for crude and age/sex‐adjusted, respectively).

Conclusion

H. pylori infection seems to be associated with anemia, and IDA among dyspeptic patients in our milieu.

Epidemiology of Helicobacter pylori in Australia: a scoping review

Background

Helicobacter pylori (H. pylori), a bacterium implicated in the development of peptic ulcer and gastric cancer, is estimated to infect around half the world's population. Its prevalence in Australia is unclear. This scoping review aimed to evaluate all Australian literature providing estimates of the prevalence of H. pylori.

Methods

Australian studies examining H. pylori prevalence from 1982 onwards were eligible for inclusion. Medline, Embase and Scopus databases, and grey literature sources, were searched. Two independent reviewers undertook a two-stage screening process. Data were extracted by two independent reviewers using a pre-specified template.

Results

Of 444 identified studies, 75 were included in the review. H. pylori prevalence in Australian population-based studies (n = 8) ranged from 38.0% in 1991 to 15.1% in 2002; however, estimated prevalence across all non-clinical population studies in diverse sub-groups (n = 29) has varied dramatically. Decreased prevalence has been more marked in populations with gastrointestinal symptoms and conditions compared to non-clinical populations. Data on H. pyloriprevalence in vulnerable populations are lacking.

Conclusions

This is the first scoping review of Australian studies reporting H. pylori prevalence. A wide range of study designs, population groups, geographic regions, and diagnostic methods was included, involving data collected over a 50-year period (1969 to 2018). The summary of H. pylori prevalence estimates over time in this review points to a decrease in prevalence in Australia, particularly among populations with gastrointestinal symptoms and illnesses; however, it is unknown whether there is inequity in prevalence trends across vulnerable sub-groups of the Australian population. Future research and interventions supporting the health and wellbeing of vulnerable populations is required to ensure equitable health gains are made for all.

Association of active Helicobacter pylori infection and anemia in elderly males

BACKGROUND

The prevalence of Helicobacter pylori (H. pylori) infection increases with age. However, the relationship between H. pylori infection and anemia in the elderly population remains to be identified. The aim of this study is to explore whether H. pylori infection is associated with anemia in a male elderly cohort.

METHODS

A cross-sectional study was designed using data collected from asymptomatic male senior citizens (≥ 65 years old) who received an assessment of their health status at the General Hospital of Chinese PLA from January 2015 to December 2015. H. pylori infection was confirmed by the ¹³C-urea breath test. Blood samples from the participants were taken to assay for hemoglobin and other erythroid-related indices - serum iron, ferritin, and C-reactive protein (CRP). Anemia was defined as hemoglobin values lower than 120.0 g/L. Charlson Comorbidity Index (CCI) was applied to establish baseline comorbidities.

RESULTS

Data from 646 subjects were analyzed. The mean age of the study cohort was 79.4 ± 8.9 years. The overall prevalence of H. pylori infection was 35.3%. The prevalence of anemia in the H. pylori positive group was higher than that in the negative group (5.3% vs. 2.2%, P = .033). Among the patients who had higher CCI scores (> 2), the prevalence of anemia in the H. pylori positive and negative groups were 10.3 and 1.4%, respectively (P = .009). Compared to the H. pylori negative group, the odds ratio for anemia of the H. pylori positive group was 2.53 (P = .033). No correlation between H. pylori infection and serum iron and ferritin levels was found. The mean corpuscular volume of the H. pylori positive and negative group was 91.17 ± 3.94 fl and 91.17 ± 4.09 fl (mean ± SD), respectively (P = .986). The CRP level in the H. pylori positive group was higher than that in the H. pylori negative group (Median: 0.17 mg/dL vs. 0.10 mg/dL, P < .001).

CONCLUSION

H. pylori infection seems to be associated with normocytic and normochromic anemia in elderly males, especially in those with more comorbidities. Further clinical studies are needed to verify the association.

Evidence of Drug-Nutrient Interactions with Chronic Use of Commonly Prescribed Medications: An Update

The long-term use of prescription and over-the-counter drugs can induce subclinical and clinically relevant micronutrient deficiencies, which may develop gradually over months or even years. Given the large number of medications currently available, the number of research studies examining potential drug-nutrient interactions is quite limited. A comprehensive, updated review of the potential drug-nutrient interactions with chronic use of the most often prescribed medications for commonly diagnosed conditions among the general U.S. adult population is presented. For the majority of the interactions described in this paper, more high-quality intervention trials are needed to better understand their clinical importance and potential consequences. A number of these studies have identified potential risk factors that may make certain populations more susceptible, but guidelines on how to best manage and/or prevent drug-induced nutrient inadequacies are lacking. Although widespread supplementation is not currently recommended, it is important to ensure at-risk patients reach their recommended intakes for vitamins and minerals. In conjunction with an overall healthy diet, appropriate dietary supplementation may be a practical and efficacious way to maintain or improve micronutrient status in patients at risk of deficiencies, such as those taking medications known to compromise nutritional status. The summary evidence presented in this review will help inform future research efforts and, ultimately, guide recommendations for patient care.

Unexplained iron deficiency anemia: does Helicobacter pylori have a role to play?

Background and aim

Testing for Helicobacter pylori (Hp) infection is recommended for work-up of unexplained iron deficiency anemia (IDA), although the evidence supporting this recommendation is scant. The aim of this study was to investigate the association between Hp infection and unexplained iron deficiency (ID) or IDA in the older adult population without significant upper gastrointestinal source of blood loss.

Methods

Retrospective single-center cohort study; 523 out of 1253 consecutive patients who underwent esophagogastroduodenoscopy with no significant upper and/or lower gastrointestinal source for blood loss or risk factors for IDA. Comparisons were made between the Hp-positive and Hp-negative groups using Fisher exact test, chi-square test and Student’s t-test. Univariate and multiple logistic regression analyses were used to identify significant risk factors associated with ID and IDA.

Results

One hundred and three subjects (19.7%) had Hp infection and 420 (80.3%) were negative for Hp. Sixty-eight (22.1%) out of 307 subjects with available serum iron profile had unexplained ID and 28 (5.4%) out of 510 subjects with available hemoglobin profile had unexplained IDA. No association was found between ID/IDA and Hp infection in univariate and multiple logistic regression analyses.

Conclusion

We found no association between unexplained ID or IDA and Hp infection in older adult population without peptic ulcer disease or significant upper gastrointestinal source of blood loss.

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.

Iron status in the elderly

Iron deficiency anaemia is prevalent in older age, particularly after the age of 80. Serum ferritin concentrations also decline, although there is no evidence to suggest that changes in iron stores are an inevitable consequence of ageing. Chronic inflammation is a common condition in older people, making the measurement of iron status difficult, and it is likely that elevated levels of circulating hepcidin are responsible for changes in iron metabolism that result in systemic iron depletion. Other contributory factors are poor diet and some medications, such as aspirin. Anaemia in older age has undesirable health outcomes, including increased susceptibility to falling and depression. However, there are concerns about possible adverse effects of iron supplements, either in relation to pro-inflammatory effects in the gut or inappropriate tissue iron deposition. Brain iron levels are increased with age-related degenerative diseases, but it is not known if this is the cause or a consequence of the disease, and genetic factors are likely to play a role. In order to maintain body iron within the normal range a personalised approach is required, taking into account all of the factors that may affect iron metabolism and the available strategies for preventing iron deficiency or overload.

Association between Helicobacter pylori infection detected by the (13) C-urea breath test and low serum ferritin levels among Japanese adults

BACKGROUND

Helicobacter pylori infection is a major risk factor for chronic gastritis, digestive ulcers, and gastric cancer. Previous studies have shown associations between H. pylori infection and decreased iron storage. Therefore, this study aimed to examine the associations between H. pylori infection and serum iron and ferritin levels in Japan.

MATERIALS AND METHODS

Overall, 268 Japanese individuals who visited a clinic located in an urban area for H. pylori infection tests and subsequent eradication were enrolled. H. pylori infection was diagnosed by a (13) C-urea breath test, with positive results defined as values ≥2.5‰.

RESULTS

The overall infection rate was 65.3% (175/268). The geometric mean serum iron levels in uninfected and infected subjects were 115.7 μg/dL and 108.9 μg/dL, respectively, in men, and 83.9 and 91.8 μg/dL, respectively, in women. The geometric mean serum ferritin levels were 128.9 and 81.0 ng/mL, respectively, in men, and 25.5 and 27.0 ng/mL, respectively, in women. Regression analysis adjusted for age showed that lower geometric mean serum ferritin levels were significantly associated with H. pylori infection in men (131.8 vs 79.4 ng/mL p = .009) and in women (33.9 vs 23.4 ng/mL p = .041). The difference was greater in subjects ≥50 years old, although the interaction was not statistically significant. Helicobacter pylori infection was not significantly associated with serum iron levels.

CONCLUSION

This study showed that H. pylori infection was significantly associated with altered serum ferritin levels in Japanese individuals, particularly in those aged ≥50 years.

Implication of antithrombotic agents on potential bleeding from endoscopically determined peptic ulcers, incidentally detected as surrogate markers for nsaids-associated ulcers complication

BACKGROUND AND AIM

Little is known about the clinical significance of treatment for endoscopically determined peptic ulcers (EPU), incidentally detected as surrogate endpoints for non-steroidal anti-inflammatory drugs (NSAIDs)-associated ulcers complication, such as overt bleeding and perforation. Even uncomplicated-EPU without overt bleeding signs when antithrombotic agents (AT) were cotherapied may be of potential bleeding sites. The aim of the present study was to evaluate whether microcytic anemia, implying potential bleeding, is associated with NSAIDs-associated EPU or cotherapies with AT.

METHODS

Two hundred and thirty-eight outpatients with rheumatoid arthritis under long-term NSAIDs therapies underwent upper endoscopy and were divided into the following four groups according to the pattern (presence: + or absence: -) of AT cotherapy/EPU, respectively: A, -/- (n = 165); B, -/+ (n = 44); C, +/- (n = 25); and D, +/+ (n = 4).

RESULTS

EPU were found in 48 of the 238 studied patients (20.2%). After significant interactions among four groups hadstatistically been identified, hemoglobin (Hb) and mean corpuscular volume (MCV) as biomarkers for potential bleeding were compared between the groups.Hb and MCV were significantly lower in the D group than in the A,B, or C groups (Hb: P < 0.01, respectively; P < 0.05, MCV; P < 0.01 or P < 0.05, respectively).

CONCLUSIONS

Patients with NSAIDs-associated EPU and AT cotherapy indicated significantly more severe microcytic anemia pattern than those without EPU or AT cotherapy, despite no evidence of overt bleeding. Even uncomplicated-EPU without overt bleeding when ATs were cotherapied may be of potential bleeding sites.

[Role of Helicobacter pylori infection in iron deficiency anemia]

Anemia induced by digestive diseases refers to anemia due to iron deficiency. Conventional gastrointestinal diagnostic workup fails to establish the cause of iron deficiency in about one third of patients. Abnormal iron absorption is increasingly recognized as an important cause of unexplained iron deficiency. The importance of coeliac disease as a possible cause of iron deficiency anemia refractory to oral iron treatment, without other manifestations of malabsorption syndrome, is increasingly being recognized. In addition, Helicobacter pylori (HP) has been implicated in several recent studies as a cause of iron deficiency anemia (IDA) refractory to oral iron treatment. Cure of previously refractory IDA by HP eradication provides strong evidence supporting a cause-and-effect relationship. In order to establish a cause-and-effect relationship between HP gastritis and IDA, prospective randomized studies comparing the effects of iron administration with or without H. pylorieradication are highly recommended.

Prevalence of Helicobacter pylori positivity in patients undergoing percutaneous coronary intervention

BACKGROUND

The adverse effect of haemorrhagic complications after percutaneous coronary intervention (PCI) on outcome is well established with Helicobacter pylori infection known to be an important precipitant of peptic ulcer disease in patients receiving non-steroidal anti-inflammatory drug therapy. The prevalence of H. pylori positivity in patients undergoing PCI and receiving subsequent antiplatelet therapy is unknown.

AIMS

We sought to determine the prevalence and features associated with H. pylori positivity in patients undergoing PCI.

METHODS

All patients undergoing PCI between August 2008 and April 2009 were identified and assessed for H. pylori positivity with serological status determined by using a commercially supplied enzyme-linked immunosorbent assay.

RESULTS

A total of 245 patients undergoing PCI during the study period had samples obtained for H. pylori serology. Of these, 91 were positive for H. pylori serology (37%) and 148 were negative (60%) with six samples being equivocal (3%). Of those patients positive for H. pylori, 75% were on agents at admission known to promote or precipitate gastrointestinal haemorrhage. Patients positive for H. pylori tended to be older, with increased creatinine and more likely to be receiving proton pump inhibitor therapy.

CONCLUSIONS

In an unselected cohort of patients undergoing PCI in a single centre, we detected a prevalence of H. pylori positivity in 37% of patients; this denotes a potentially treatable precipitant of haemorrhage in a considerable portion of patients receiving dual antiplatelet therapy after PCI. Further prospective study is required to determine if the presence of H. pylori positivity is associated with adverse events in terms of gastrointestinal and cardiac outcomes.

Helicobacter pylori infection and iron stores: a systematic review and meta-analysis

BACKGROUND AND AIMS

We carried out a systematic literature review and meta-analysis to evaluate the existing evidence on the association between Helicobacter pylori infection and iron stores.

METHODS

Twelve case reports and case series, 19 observational epidemiologic studies and six intervention trials were included in the review.

RESULTS

Although only few studies controlled for multiple potential confounders, most studies reported a positive association, linking between H. pylori and decreased body iron stores in symptomatic and asymptomatic H. pylori-infected subjects. H. pylori infection may be regarded as a risk factor for reduction in body iron stores and also for iron deficiency or iron deficiency anemia, especially in high-risk groups. The results of the meta-analysis of thoroughly designed and analyzed studies revealed an increased risk for iron deficiency anemia; pooled odds ratio (OR) 2.8 (95% confidence interval (CI) 1.9, 4.2) and also for iron deficiency; pooled OR 1.38 (95%CI 1.16-1.65) among H. pylori-infected subjects. The biologic mechanism by which H. pylori induces the alteration in the iron stores is not fully understood, but it seems to involve several pathways, including gastrointestinal blood loss, decrease in the absorption of dietary iron, and enhanced uptake of the iron by the bacterium.

CONCLUSIONS

H. pylori is associated with reduced iron stores. Future research is needed to determine whether this relationship is a causal association and to better understand its biologic mechanism. The impact of anti-H. pylori therapy on improvement of iron stores needs to be further evaluated in large and well-controlled trials.

Helicobacter pylori eradication therapy: indications, efficacy and safety

BACKGROUND

Helicobacter pylori infects up to half of the world's population. It remains the major cause of peptic ulcer disease and is recognised as a carcinogen for its role in gastric carcinogenesis. Successful eradication of the bacteria is associated with improved health outcomes including fewer dyspeptic symptoms, reduced peptic ulcer recurrence and rebleeding, reduced peptic ulcer risk with NSAIDs and as a cure for low-grade gastric MALT lymphoma. The risk of gastric cancer is reduced in those without premalignant mucosal abnormalities at the time of eradication.

OBJECTIVE

This review outlines the current indications and options for therapy of H. pylori with particular reference to drug-induced adverse events associated with treatment.

METHODS

The indications for H. pylori eradication are evidence-based and in accordance with recent consensus statements and recommendations. The eradication treatment is based on numerous clinical trials and meta-analyses.

RESULTS/CONCLUSION

Eradication therapy, in general, is safe and well tolerated. Antibiotic therapy may be associated with significant drug adverse reactions, especially gastrointestinal symptoms.

Neural tube defects, micronutrient deficiencies, and Helicobacter pylori: a new hypothesis

BACKGROUND

Previous findings for the Texas Neural Tube Defects Project suggested that while maternal access to nutrients is adequate, bioavailability of nutrients to the fetus is compromised in NTD-affected pregnancies. Helicobacter pylori could cause nutrient loss to the fetus. Folate, B12, and ferritin are depleted in H. pylori infection; these same deficiencies are related to NTD risk.

METHODS

Using H. pylori IgG ELISA Test System, we tested for H. pylori serum antibodies in participants in the population-based case-control study component of the Texas Neural Tube Defect Project conducted along the Texas-Mexico border. Case-women had pregnancies affected by NTD (anencephalus, spina bifida, encephalocele) and resided and delivered in one of the 14 Texas-Mexico border counties from 1995 through 2000. Control-women were study area residents delivering normal live births during the same period.

RESULTS

Of 225 case- and 378 control-women, 103 cases and 156 controls provided questionnaire and H. pylori antibody data. H. pylori seropositivity was modestly associated with NTD-affected pregnancies (OR 1.4; 95% CI: 0.8-2.4). ORs of 2.0 or greater were seen in women younger than age 25 and with less than 7 years education.

CONCLUSIONS

Our findings intimate that H. pylori could play a role in NTD causation in certain populations. While results did not provide compelling support for this proposal, subgroup findings prompt us to advocate an evaluation of this hypothesis in developing nations among populations with higher prevalence of H. pylori, marginal nutrient intake, and young childbearing age.

Helicobacter pylori and extragastric diseases--other Helicobacters

Reports on Helicobacter pylori and extragastric diseases have almost doubled this year compared with last year, bearing witness to the persistent scientific interest in this branch of Helicobacter-related pathology. Data belong increasingly to the area of vascular medicine, as well as hematology, dermatology, pediatrics and other fields. Unfortunately, these studies show overall controversial results, due to the impact of several confounding factors, and to the difficulty of recruiting homogeneous patient populations. Furthermore, many studies continue to be conducted on Helicobacter species other than H. pylori, focusing on animal models of gastroenterological illnesses which may retain strong similarities with human diseases. In this paper, taxonomy, detection and characterisation of Helicobacter spp. will be reviewed, together with the most important data issued this year on other Helicobacters and animal models.