Investigating iron deficiency anemia without clinical evidence of gastrointestinal blood loss

Association Between Helicobacter pylori Infection and Serum Iron Profile

Introduction: Helicobacter pylori (H. pylori) infection is reported to be the most frequent cause of morbidity and mortality in cases of upper gastrointestinal (GI) diseases. There is paucity of research between the possible association of H. pylori and iron stores and iron deficiency anemia (IDA). In this study, we will determine if there is an association between serum total iron-binding capacity (TIBC), serum iron and ferritin levels, and H. pylori infection.

Methods: This case-control study was conducted in the gastroenterology ward of a major hospital in Pakistan from December 2020 to April 2021. Three hundred patients diagnosed with H. pylori were enrolled along with 300 participants in the control group. H. pylori was confirmed or excluded with the help of Giemsa stained gastric biopsy specimens. Blood was sent to the laboratory to test for ferritin, serum iron, and TIBC. Each sample was drawn in the morning to avoid any fluctuations.

Results: The mean serum iron level was significantly lower in participants with H. pylori infection compared to those who did not have H. pylori infection (110.72 ± 28.38 ug/dL vs. 162.5 ± 21.18 ug/dL; p-value: <0.0001). Serum ferritin level was significantly higher in participants with H. pylori infection (536.82 ± 117.0 ng/dL vs. 391.31 ± 101.54 ng/dL; p-value: <0.0001).

Conclusion: In comparison with the control group, TIBC and serum iron levels were found to be lower in the case group.

Effect of Helicobacter pylori Treatment on Unexplained Iron Deficiency Anemia

BACKGROUND

A large number of patients with iron deficiency anemia have no known cause of their anemia despite a full evaluation. Optimal management and follow-up for this issue is unclear. Results of previous studies have implicated Helicobacter pylori infection as a potential cause of iron deficiency anemia.

OBJECTIVES

To investigate whether H pylori infection could be a cause of unexplained iron deficiency anemia.

METHODS

All adult patients with both unexplained iron deficiency anemia and H pylori infection diagnosed between January 1, 2008 and April 30, 2015 were identified from Kaiser Permanente Northern California's electronic medical records database and were followed-up for up to 2 years. We employed bivariate statistics to analyze demographic and clinical characteristics between H pylori treatment groups (treated and untreated). Multivariable logistic regression was used to assess the odds of continued presence of anemia at follow-up.

RESULTS

Of 508 subjects who fit our inclusion criteria, 408 subjects were treated for H pylori. The median initial level of hemoglobin was 10.5 g/dL and ferritin was 7.0 ng/mL. No difference existed in the continued presence of iron deficiency anemia at follow-up between those treated for H pylori and those not treated (24.3% vs 26.5%, p = 0.71). Both groups had improved levels of hemoglobin (25.4% mean increase in treated vs 27.5% mean increase in untreated) at follow-up.

CONCLUSION

In contrast to the findings of previous studies, we found no evidence that H pylori is involved in causing iron deficiency anemia. Iron deficiency anemia resolved in most subjects regardless of H pylori treatment status.

Practical gastrointestinal investigation of iron deficiency anaemia

About 10% of oesophagogastroduodenoscopies (OGDs) and colonoscopies are done for investigation of iron deficiency anemia (IDA) . Much of the existing guidance on investigation of IDA predates CRC screening, which has driven significant improvements in colonoscopy quality and completion rates, as well as a reduction in Helicobacter pylori prevalence and increase in PPI usage, and therefore probably needs re-consideration. New investigations, e.g. CT colonography, enteroscopy and capsule endoscopy have also been introduced. Areas covered: This review updates the approach to practical investigation of IDA. Medline was searched using the terms iron deficiency AND anemia AND/OR gastroscopy, colonoscopy, capsule and enteroscopy, together with review of recent relevant published abstracts on the topic. Expert commentary: Gastrointestinal pathology is now a more common cause of IDA than upper GI causes, reflecting better colonoscopy accuracy and completion rates as well as changing disease patterns, and carcinomas are more likely cause IDA than benign adenomas. Increasing use of antiplatelet and anticoagulants is driving greater presentation of IDA. Capsule endoscopy, enteroscopy and CT colonography are increasingly used. Fecal occult blood testing may be a useful simple screening method in the frail, as a negative test can avoid the need for invasive tests.