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Iriarte-Gahete M, Tarancon-Diez L, Garrido-Rodríguez V, Leal M, Pacheco YM. Absolute and functional iron deficiency: Biomarkers, impact on immune system, and therapy. Blood Rev 2024:101227. [PMID: 39142965 DOI: 10.1016/j.blre.2024.101227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 08/02/2024] [Accepted: 08/07/2024] [Indexed: 08/16/2024]
Abstract
Iron is essential for numerous physiological processes and its deficiency often leads to anemia. Iron deficiency (ID) is a global problem, primarily affecting reproductive-age women and children, especially in developing countries. Diagnosis uses classical biomarkers like ferritin or transferrin saturation. Recent advancements include using soluble transferrin receptor (sTfR) or hepcidin for improved detection and classification of absolute and functional iron deficiencies, though mostly used in research. ID without anemia may present symptoms like asthenia and fatigue, even without relevant clinical consequences. ID impacts not only red-blood cells but also immune system cells, highlighting its importance in global health and immune-related comorbidities. Managing ID, requires addressing its cause and selecting appropriate iron supplementation. Various improved oral and intravenous products are available, but further research is needed to refine treatment strategies. This review updates on absolute and functional iron deficiencies, their relationships with the immune system and advancements in diagnosis and therapies.
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Affiliation(s)
- Marianela Iriarte-Gahete
- Immunology Service, Unit of Clinical Laboratories, Institute of Biomedicine of Seville, IBiS / Virgen del Rocío University Hospital / CSIC / University of Seville, Seville, Spain
| | - Laura Tarancon-Diez
- Group of Infections in the Pediatric Population, Health Research Institute Gregorio Marañón (IiSGM), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Vanesa Garrido-Rodríguez
- Immunology Service, Unit of Clinical Laboratories, Institute of Biomedicine of Seville, IBiS / Virgen del Rocío University Hospital / CSIC / University of Seville, Seville, Spain
| | - Manuel Leal
- Internal Medicine Service, Viamed Santa Ángela de la Cruz Hospital, Seville, Spain
| | - Yolanda María Pacheco
- Immunology Service, Unit of Clinical Laboratories, Institute of Biomedicine of Seville, IBiS / Virgen del Rocío University Hospital / CSIC / University of Seville, Seville, Spain; Universidad Loyola Andalucía, Facultad de Ciencias de la Salud, Campus Sevilla, 41704, Dos Hermanas, Sevilla, Spain.
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Tarancon-Diez L, Iriarte-Gahete M, Sanchez-Mingo P, Perez-Cabeza G, Romero-Candau F, Pacheco YM, Leal M, Muñoz-Fernández MÁ. Real-world experience of intravenous iron sucrose supplementation and dynamics of soluble transferrin receptor and hepcidin in a Spanish cohort of absolute iron deficient patients. Biomed Pharmacother 2023; 167:115510. [PMID: 37757490 DOI: 10.1016/j.biopha.2023.115510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 09/01/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
The study evaluated the safety and effectiveness of the generic intravenous (IV) iron treatment (Feriv®), in a Spanish cohort with absolute iron deficiency (ID) (serum ferritin <50 ng/ml, with or without anaemia) (n = 122; 91% women; median age of 44 years [IQR: 33.7-54]). Iron-related biomarkers were measured before treatment (baseline), 2 weeks after beginning the protocol (intermediate control, IC) and between 7 and 10 days after treatment completion (final time-point). Primary efficacy endpoints were ferritin levels ≥ 50 ng/ml, anaemia restoration or an increase in haemoglobin (Hb) of at least one point in patients without baseline anaemia. After treatment, iron-related biomarkers improved, including ferritin, Hb, sideremia, transferrin, transferrin saturation index, soluble transferrin receptor (sTfR), and hepcidin. Baseline ferritin concentration (13.5 ng/ml [IQR: 8-24.2]) increased at the IC and continued rising at the final time-point, reaching a median ferritin of 222 ng/ml and 97.3% of patients ≥ 50 ng/ml. At the final time-point, anaemia prevalence decreased from 26.2% to 5%, while the 34.1% without baseline anaemia showed an increase in Hb of at least one point. Headache was the only drug-adverse event recorded in 2.3% of patients. At a late time-point (27.5 median weeks after ending therapy [IQR: 22-40]), evaluated in a subgroup of 66 patients, 18% had ferritin levels < 50 ng/ml. Multivariate analysis showed that low baseline ferritin and high sTfR/hepcidin ratio tended to be independently associated with ID recurrence. Feriv® is a safe, effective first-line treatment for absolute ID, with improvement of serum ferritin and Hb. ID recurrence was associated with the baseline degree of iron stores depletion, indicated by serum ferritin, and sTfR/hepcidin ratio.
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Affiliation(s)
- Laura Tarancon-Diez
- Molecular Immunology Laboratory, Hospital General Universitario Gregorio Marañón, Health Research Institute Gregorio Marañón (IiSGM), Madrid, Spain; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Marianela Iriarte-Gahete
- Immunology Service, Unit of Clinical Laboratories, Institute of Biomedicine of Seville, IBiS / Virgen del Rocío University Hospital / CSIC / University of Seville, Seville, Spain
| | | | | | | | - Yolanda M Pacheco
- Immunology Service, Unit of Clinical Laboratories, Institute of Biomedicine of Seville, IBiS / Virgen del Rocío University Hospital / CSIC / University of Seville, Seville, Spain
| | - Manuel Leal
- Internal Medicine Service, Hospital Santa Ángela de la Cruz, Seville, Spain
| | - Maria Ángeles Muñoz-Fernández
- Molecular Immunology Laboratory, Hospital General Universitario Gregorio Marañón, Health Research Institute Gregorio Marañón (IiSGM), Madrid, Spain; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
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Szpakowski JL, Tucker LY. Iron deficiency and symptoms in women aged 20-49 years and relation to upper gastrointestinal and colon cancers. BMJ Open Gastroenterol 2022; 9:e000947. [PMID: 35896276 PMCID: PMC9335060 DOI: 10.1136/bmjgast-2022-000947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 07/06/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Iron deficiency anaemia (IDA) in women aged 20-49 years may be caused by menses or gastrointestinal cancer. Data are sparse on the yield of endoscopy/colonoscopy in this population. Our aim was to determine the association of IDA and symptoms with cancers. DESIGN Retrospective cohort study within Kaiser Permanente Northern California. Participants were women aged 20-49 years tested for iron stores and anaemia during 1998, 2004 and 2010 and followed for 5 years for outcomes of oesophageal, gastric and colon cancers. Symptoms from the three prior years were grouped into dysphagia, upper gastrointestinal (UGI), lower gastrointestinal (LGI), rectal bleeding and weight loss. RESULTS Among 9783 anaemic women aged 20-49 years, there were no oesophageal, 6 gastric and 26 colon cancers. Incidences per 1000 for gastric cancer with and without iron deficiency (ID) were 0.60 (95% CI 0.23 to 1.55) and 0.63 (95% CI 0.17 to 2.31), and for colon cancer, 2.72 (95% CI 1.72 to 4.29) and 2.53 (95% CI 1.29 to 4.99). Endoscopies for UGI or dysphagia symptoms rather than bidirectional endoscopy for ID yielded more gastric cancers (n=5 and n=4, respectively) with fewer procedures (3793 instead of 6627). Colonoscopies for LGI or rectal bleed instead of for ID would detect more colon cancers (n=19 and n=18) with about 40% of the procedures (=2793/6627). CONCLUSIONS UGI and colon cancers were rare in women of menstruating age and when controlled for anaemia were as common without as with ID. Using symptoms rather than IDA as an indication for endoscopy found equal numbers of cancers with fewer procedures.
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Affiliation(s)
- Jean-Luc Szpakowski
- Department of Gastroenterology, Kaiser Permanente Northern California, Fremont, California, USA
| | - Lue-Yen Tucker
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
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Odhaib SA, Mohammed MJ, Hammadi SS. Gastrointestinal Endoscopic Outcome in Late Adolescent Women With Iron-Deficiency Anemia in Basrah-Iraq: A Multicenter Study. Cureus 2021; 13:e14630. [PMID: 34046268 PMCID: PMC8140649 DOI: 10.7759/cureus.14630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Iron deficiency anemia (IDA) in late adolescent women has multiple pathophysiologies. Silent blood loss, celiac disease (CD), malignancies, and other gastrointestinal (GI) lesions receive much attention during IDA management. There is no consensus about endoscopic screening. Our study evaluates factors affecting GI endoscopic diagnosis for the etiology of IDA in late adolescent women. Materials and Methods We conducted an observational, multicenter retrospective analysis of 192 adolescent women with IDA admitted for GI endoscopic diagnosis from 2006 to 2016. Baseline measurements included hemoglobin, serum ferritin, mean corpuscular volume, serum iron, total iron-binding capacity, and transferrin saturation. We collected demographic characteristics, duration of hospital stay, the degree of severity of anemia, and endoscopic findings. Results The mean age was 19±1 years (range 17 to 21 years), with mildly to moderately severe IDA. Patients received esophagogastroduodenoscopy (EGD, n=178) or colonoscopy (n=14). The mean hospital stay was 2.0±1.0 days. We found negative endoscopies (n=74), CD (n=85), gastric ulcer (n=19), malignancy (n=2), inflammatory bowel disease (n=1), and other nonsignificant endoscopic findings (n=11). We found no correlation between the duration of the hospital stay with the severity of IDA, no significant association between GI symptoms of the patients with endoscopic findings, and a significant but weak association between GI symptoms and serum ferritin. Conclusions In late adolescent women with IDA who have significant GI endoscopic lesions, the GI symptoms are of limited value in guiding the endoscopic diagnostic approach for evaluation of IDA.
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Affiliation(s)
- Samih A Odhaib
- Adult Endocrinology, Faiha Specialized Diabetes, Endocrine and Metabolism Center, College of Medicine, University of Basrah, Basrah, IRQ
| | - Miaad J Mohammed
- Diagnostic Radiology, Al-Refaee General Hospital, Thi-Qar Health Directorate, Thi-Qar, IRQ
| | - Saad S Hammadi
- Internal Medicine, College of Medicine, University of Basrah, Basrah, IRQ
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Odhaib SA, Mohammed MJ, Hammadi SS. Do Gastrointestinal Symptoms Affect the Endoscopic Outcome in Anemic Premenopausal Women Due to Iron Deficiency: A Multicenter Study From Basrah-Iraq. Cureus 2021; 13:e14524. [PMID: 34007772 PMCID: PMC8121207 DOI: 10.7759/cureus.14524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The most common cause for iron deficiency anemia (IDA) in women before menopause is menstrual blood loss. The persistence of digestive symptoms despite iron supplementation is the only indication for gastrointestinal (GI) endoscopy in premenopausal women (PW) with IDA. We evaluated how the GI symptomatology manifestation affects the GI endoscopy diagnostic outcome in this cohort. MATERIALS AND METHODS This is an observational, multicenter retrospective evaluation of 245 PW admitted for GI endoscopic diagnosis for the etiology of IDA from 2006 to 2016. Baseline measurements included hemoglobin, iron status tests, and red blood corpuscle morphological evaluation. We evaluated the relationships of different endoscopic findings to the severity of IDA, different demographic characteristics, and hospitalization duration. RESULTS The mean age was 40±7 years. The duration of hospitalization was neither associated with age nor the IDA severity. The IDA was mild to moderate. More than 53% (n=131) had either a negative study or nonspecific inflammatory changes. Around 16% (n=39) had GI malignancies. There was a significant association between initial GI symptoms with endoscopic GI finding and GI malignancy diagnosis in particular. The relationship loses its power during further assessment by general univariate analysis. CONCLUSION A considerable percentage of anemic PW due to iron deficiency has an endoscopically-diagnosed pathology for IDA determined during GI endoscopy. The GI symptoms' phenotypes were unrelated to the endoscopically-diagnosed GI lesion location, even if they were malignant. Therefore, the determination of IDA severity must be thoroughly and individually determined.
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Affiliation(s)
- Samih A Odhaib
- Adult Endocrinology, Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC) College of Medicine, University of Basrah, Basrah, IRQ
| | - Miaad J Mohammed
- Diagnostic Radiology, Al-Refaee General Hospital, Thi-Qar Health Directorate, Thi-Qar, IRQ
| | - Saad S Hammadi
- Internal Medicine, College of Medicine, University of Basrah, Basrah, IRQ
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Rockey DC, Altayar O, Falck-Ytter Y, Kalmaz D. AGA Technical Review on Gastrointestinal Evaluation of Iron Deficiency Anemia. Gastroenterology 2020; 159:1097-1119. [PMID: 32828801 PMCID: PMC10824166 DOI: 10.1053/j.gastro.2020.06.045] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Don C Rockey
- Digestive Disease Research Center, Medical University of South Carolina, Charleston, South Carolina
| | - Osama Altayar
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri
| | - Yngve Falck-Ytter
- Department of Medicine and Gastroenterology, Case Western Reserve; University; Veterans Affairs Northeast Ohio Health System, Cleveland, Ohio
| | - Denise Kalmaz
- Division of Gastroenterology, University of California, San Diego, California
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López-García YK, Colunga-Pedraza PR, Tarín-Arzaga L, López Garza MI, Jaime-Pérez JC, Gómez-Almaguer D. Iron deficiency anemia referral to the hematologist. Real-world data from Mexico: the need for targeted teaching in primary care. Hematology 2018; 23:658-663. [DOI: 10.1080/10245332.2018.1461290] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Yadith Karina López-García
- Hematology Service, Hospital Universitario ‘Dr. José Eleuterio González’, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Perla Rocío Colunga-Pedraza
- Hematology Service, Hospital Universitario ‘Dr. José Eleuterio González’, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Luz Tarín-Arzaga
- Hematology Service, Hospital Universitario ‘Dr. José Eleuterio González’, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Mariana Itzel López Garza
- Hematology Service, Hospital Universitario ‘Dr. José Eleuterio González’, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - José Carlos Jaime-Pérez
- Hematology Service, Hospital Universitario ‘Dr. José Eleuterio González’, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - David Gómez-Almaguer
- Hematology Service, Hospital Universitario ‘Dr. José Eleuterio González’, Universidad Autónoma de Nuevo León, Monterrey, Mexico
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[Diagnostic approach to iron deficiency anemia]. Wien Med Wochenschr 2016; 166:402-410. [PMID: 27565993 DOI: 10.1007/s10354-016-0495-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 07/11/2016] [Indexed: 10/21/2022]
Abstract
Anemia affects a fourth of the global population, with iron deficiency remaining the primary cause. It is associated with diminished work capacity, fatigue, impaired cognitive function, and can negatively impact the course of diseases like chronic heart failure or chronic kidney disease. Treatment options include oral and intravenous iron; however, conditions such as inflammatory bowel disease, celiac disease, or autoimmune gastritis can diminish the efficacy of oral iron. Timely recognition of iron deficiency anemia and administration of appropriate therapy not only improves quality of life, but also reduces the need for blood transfusions. Proper selection of iron-deficient patients for whom further diagnostic testing is necessary facilitates identification of underlying diseases that require specific treatment, and avoids unnecessary invasive testing.
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Prevalence of heavy menstrual bleeding and experiences of affected women in a European patient survey. Int J Gynaecol Obstet 2014; 128:196-200. [DOI: 10.1016/j.ijgo.2014.09.027] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 09/02/2014] [Accepted: 11/21/2014] [Indexed: 11/21/2022]
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Queiroz DMM, Harris PR, Sanderson IR, Windle HJ, Walker MM, Rocha AMC, Rocha GA, Carvalho SD, Bittencourt PFS, de Castro LPF, Villagrán A, Serrano C, Kelleher D, Crabtree JE. Iron status and Helicobacter pylori infection in symptomatic children: an international multi-centered study. PLoS One 2013; 8:e68833. [PMID: 23861946 PMCID: PMC3701645 DOI: 10.1371/journal.pone.0068833] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 06/02/2013] [Indexed: 12/11/2022] Open
Abstract
Objective Iron deficiency (ID) and iron deficiency anaemia (IDA) are global major public health problems, particularly in developing countries. Whilst an association between H. pylori infection and ID/IDA has been proposed in the literature, currently there is no consensus. We studied the effects of H. pylori infection on ID/IDA in a cohort of children undergoing upper gastrointestinal endoscopy for upper abdominal pain in two developing and one developed country. Methods In total 311 children (mean age 10.7±3.2 years) from Latin America - Belo Horizonte/Brazil (n = 125), Santiago/Chile (n = 105) - and London/UK (n = 81), were studied. Gastric and duodenal biopsies were obtained for evaluation of histology and H. pylori status and blood samples for parameters of ID/IDA. Results The prevalence of H. pylori infection was 27.7% being significantly higher (p<0.001) in Latin America (35%) than in UK (7%). Multiple linear regression models revealed H. pylori infection as a significant predictor of low ferritin and haemoglobin concentrations in children from Latin-America. A negative correlation was observed between MCV (r = −0.26; p = 0.01) and MCH (r = −0.27; p = 0.01) values and the degree of antral chronic inflammation, and between MCH and the degree of corpus chronic (r = −0.29, p = 0.008) and active (r = −0.27, p = 0.002) inflammation. Conclusions This study demonstrates that H. pylori infection in children influences the serum ferritin and haemoglobin concentrations, markers of early depletion of iron stores and anaemia respectively.
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Queiroz DMM, Rocha AMC, Melo FF, Rocha GA, Teixeira KN, Carvalho SD, Bittencourt PFS, Castro LPF, Crabtree JE. Increased gastric IL-1β concentration and iron deficiency parameters in H. pylori infected children. PLoS One 2013; 8:e57420. [PMID: 23451225 PMCID: PMC3581450 DOI: 10.1371/journal.pone.0057420] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 01/21/2013] [Indexed: 12/13/2022] Open
Abstract
Association between H. pylori infection, iron deficiency and iron deficiency anaemia has been described, but the mechanisms involved have not been established. We hypothesized that in H. pylori infected children increased gastric concentrations of IL-1β and/or TNF-α, both potent inhibitors of gastric acid secretion that is essential for iron absorption, are predictors for low blood concentrations of ferritin and haemoglobin, markers of early depletion of iron stores and anaemia, respectively. We evaluated 125 children undergoing endoscopy to clarify the origin of gastrointestinal symptoms. Gastric specimens were obtained for H. pylori status and cytokine evaluation and blood samples for determination of iron deficiency/iron deficiency anaemia parameters and IL1 cluster and TNFA polymorphisms that are associated with increased cytokine secretions. Higher IL-1β and TNF-α gastric concentrations were observed in H. pylori-positive (n = 47) than in -negative (n = 78) children. Multiple linear regression models revealed gastric IL-1β, but not TNF-α, as a significant predictor of low ferritin and haemoglobin concentrations; results were reproduced in young children in whom IL1RN polymorphic genotypes associated with higher gastric IL-1β expression and lower blood ferritin and haemoglobin concentrations. In conclusion, high gastric levels of IL-1β can be the link between H. pylori infection and iron deficiency/iron deficiency anaemia in childhood.
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Abdulqawi K, El-Mahalaway AM, Abdelhameed A, Abdelwahab AA. Correlation of serum antibody titres with invasive methods for rapid detection of Helicobacter pylori infections in symptomatic children. Int J Exp Pathol 2012; 93:295-304. [PMID: 22804766 DOI: 10.1111/j.1365-2613.2012.00831.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Helicobacter pylori (H. pylori) is causally associated with peptic ulcer disease and gastric carcinoma. Typically, children get infected during the first decade of life, but diseases associated with H. pylori are seen mainly in adults. Multiple diagnostic methods are available for the detection of H. pylori infection. The aim of this study was to evaluate the correlation and diagnostic accuracy of three invasive methods [rapid urease test (RUT), histology and bacterial culture] and one non-invasive method (IgG serology) for diagnosis of H. pylori infection in a prospective cohort study conducted on 50 symptomatic children between two and eighteen years of age. Endoscopies with gastric biopsies were performed for RUT, culture and histopathological examination, respectively. IgG antibodies were measured in patient sera using a commercially available enzyme-linked immunosorbent assay (ELISA). RUT and positive H. pylori IgG antibodies were concordant in 88% (44/50) of patients. Both tests were negative in 32% (16/50), and both were positive in 56% (28/50). Disagreement occurred in 12% (6/50) of the patients: three of them (6%) had positive RUT and negative H. pylori IgG, and another three (6%) had negative RUT and positive H. pylori IgG. A combination of RUT with non-invasive serology constituted the optimum approach to the diagnosis of H. pylori infection in symptomatic children. The non-invasive serological test (ELISA) could not be used alone as the gold standard because it cannot distinguish between active and recently treated infection; and bacterial culture could not be used alone because of its low sensitivity.
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Affiliation(s)
- Khaled Abdulqawi
- Department of Pediatrics, Benha Faculty of Medicine, Benha University, Benha, Egypt.
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Abstract
Iron-deficiency anaemia, the condition in which anaemia occurs due to a lack of iron, develops when the amount of available iron is insufficient to support normal red blood cell production. Iron deficiency and iron-deficiency anaemia, very prevalent conditions in premenopausal women, are often associated with menometrorrhagia (present in more than two-thirds of cases of iron-deficiency anaemia in premenopausal women). Appropriate identification and treatment of iron deficiency is imperative as iron deficiency can induce important specific clinical manifestations (including fatigue, atrophic changes in the epithelium, oral lesions, dysphagia, nail lesions, reduced immune response). Iron supplementation is the most common strategy used to control iron deficiency. Based on World Health Organisation recommendations, the most appropriate treatment is with an oral ferrous salt in a prolonged-release tablet form, to provide a dose of elemental iron equivalent to 60 mg per intake, in the range of 60 and 120 mg/day according to the severity of iron-deficiency anaemia. When haemoglobin levels have returned to normal, treatment should continue for about 3 months to fill iron stores. An extended-release formulation of ferrous sulphate with mucoproteose has been shown to be associated with a lower incidence of gastrointestinal adverse effects compared with other ferrous and ferric salts.
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Vannella L, Gianni D, Lahner E, Amato A, Grossi E, Fave GD, Annibale B. Pre-endoscopic screening for Helicobacter pylori and celiac disease in young anemic women. World J Gastroenterol 2009; 15:2748-53. [PMID: 19522025 PMCID: PMC2695890 DOI: 10.3748/wjg.15.2748] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the usefulness of pre-endoscopic serological screening for Helicobacter pylori (H pylori) infection and celiac disease in women aged < 50 years affected by iron-deficiency anemia (IDA).
METHODS: One hundred and fifteen women aged < 50 years with IDA were tested by human recombinant tissue transglutaminase IgA antibodies (tTG) and anti-H pylori IgG antibodies. tTG and H pylori IgG antibody were assessed using an enzyme-linked immunosorbent assay (ELISA). All women were invited to undergo upper GI endoscopy. During gastroscopy, biopsies were collected from antrum (n = 3), gastric body (n = 3) and duodenum (n = 4) in all patients, irrespective of test results. The assessment of gastritis was performed according to the Sydney system and celiac disease was classified by Marsh’s System.
RESULTS: 45.2% women were test-positive: 41 patients positive for H pylori antibodies, 9 patients for tTG and 2 patients for both. The gastroscopy compliance rate of test-positive women was significantly increased with respect to those test-negative (65.4% vs 42.8%; Fisher test P = 0.0239). The serological results were confirmed by gastroscopy in 100% of those with positive H pylori antibodies, in 50% of those with positive tTG and in 81.5% of test-negative patient. Sensitivity and specificity were 84.8% and 100%, respectively for H pylori infection and, 80% and 92.8% for tTG. Twenty-eight patients had positive H pylori antibodies and in all the patients, an active H pylori infection was found. In particular, in 23 out of 28 (82%) patients with positive H pylori antibodies, a likely cause of IDA was found because of the active inflammation involving the gastric body.
CONCLUSION: Anti-H pylori IgG antibody and tTG IgA antibody testing is able to select women with IDA to submit for gastroscopy to identify H pylori pangastritis and/or celiac disease, likely causes of IDA.
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Abstract
PURPOSE OF REVIEW Iron deficiency anemia (IDA) still remains universally problematic worldwide. The primary focus of this review is to critique articles published over the past 18 months that describe strategies for the diagnosis and management of this prevalent condition. RECENT FINDINGS The medical community continues to lack consensus when identifying the optimal approach for the diagnosis and management of IDA. Current diagnostic recommendations revolve around the validity and practicality of current biomarkers such as soluble transferrin-receptor concentrations and others, and cause-based diagnostics that potentially include endoscopy. Management of IDA is based on supplementation combined with effective etiological treatment. Advances in oral and parenteral low-molecular-weight iron preparations has expanded and improved treatment modalities for IDA. Since the introduction of low versus high-molecular-weight intravenous iron administration, there have been fewer serious adverse events associated with parenteral iron preparations. SUMMARY Best practice guidelines for diagnosing and managing IDA should include the design of an algorithm that is inclusive of multiple biomarkers and cause-based diagnostics, which will provide direction in managing IDA, and distinguish between IDA from the anemia of chronic disease.
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