Yon Ho Choe

The purpose of this study was to determine whetherHelicobacter pylori infection can contribute to growth deficit, especially in pubescent children who need large amounts of iron for growth. A structured questionnaire was sent to the parents of 532 healthy children aged 10 to 15 years (mean 12.9) to obtain demographic information on the parents and the environment. Of the 532 questionnaires sent out, 375 (70.5%; 170 girls and 205 boys) were returned. After collecting blood samples from participants, haemoglobin, serum iron, total iron binding capacity, serum ferritin, and serum IgG antibodies to H pylori were measured. The effects of risk factors such as H pylori infection, iron deficiency anaemia, sex, socioeconomic status, type of house, and crowding index on growth were analysed using multiple regression analysis. Of 63 H pyloripositive children, 18 (28.6%) were below the 25th centile values for height, compared with 63 of 312 (20.2%) H pylori negative children. The prevalence rate ofH pylori infection was 15.5% (53 of 343) in children without iron deficiency anaemia and 31.3% (10 of 32) in those affected. The relative risk of short stature was 2.2 (95% confidence interval (CI), 1.0 to 4.8) for iron deficiency anaemia, and 1.4 (95% CI, 0.8 to 2.4) for H pylori infection. The mean height was significantly lower in the group having bothH pylori infection and iron deficiency anaemia. Therefore, H pylori infection accompanied by iron deficiency anaemia, rather thanH pylori infection per se, might delay pubertal growth.

We investigated the effect of Helicobacter pylori eradication on sideropenic refractory anaemia in adolescent girls with H. pylori‐associated antral gastritis without evidence of haemorrhage or clinical symptoms other than sideropenic anaemia. We conducted an open therapeutic trial in 21 adolescent girls aged 15–17 y with sideropenic refractory anaemia, which was defined as iron‐deficiency anaemia refractory to oral iron therapy for 3 mo. All subjects underwent gastroduodenal endoscopy. Thirteen patients with confirmed H. pylori infection were given a 2‐wk course of triple therapy and 6 wk of oral ferrous sulfate. We compared the mean levels of haemoglobin and serum ferritin among the “initial sample” (the time when the sampling was done before treatment with oral iron),“before eradication” (the time prior to triple therapy for eradication after subjects had been given oral iron for 3 mo) and “after eradication” (the time when the follow‐up endoscopy was performed) data in 11 subjects in whom H. pylori infection was eradicated. Haemoglobin levels (g/dl) were 8.6 ±1.9, 8.6 ±1.4 and 11.3 ±2.3, respectively. Serum ferritin levels (p.g/l) were 4.6 ± 2.4, 4.2 ± 2.3 and 17.5 ± 6.7, respectively. After eradication of H. pylori, mean levels of haemoglobin (p = 0.0002) and serum ferritin (p = 0.0002) showed a prominent increase between “before eradication” and “after eradication”. In conclusion, adolescent girls with sideropenic refractory anaemia should be evaluated for H. pylori infection. If H. pylori infection is coexistent, its eradication along with iron supplementation could correct the anaemia.

Background. A few cases relating H. pylori infection to iron‐deficiency anemia have been described recently. We investigated the role of H. pylori infection in iron‐deficiency anemia in preadolescent children and adolescents.Patients and Methods. We conducted a double‐blind, placebo‐controlled therapeutic trial in 43 subjects (mean age, 15.4 years) with iron‐deficiency anemia. Endoscopy was performed, and biopsy specimens were examined by urease test and histological analysis. Twenty‐two of 25 H. pylori–positive patients were assigned randomly to three groups. Group A patients were given oral ferrous sulfate and a 2‐week course of bismuth subcitrate, amoxicillin, and metronidazole. Group B patients were given placebo for iron and a 2‐week course of triple therapy. Group C patients were given oral ferrous sulfate and a 2‐week course of placebo. Iron status was reassessed 4 weeks and 8 weeks after the 2‐week regimen ended.Results. Of the 43 subjects with iron‐deficiency anemia, 25 (58.1%) had H. pylori in the antrum. Group A and B subjects, who received eradication therapy, showed a significant increase in hemoglobin level as compared with group C subjects at 8 weeks after therapy (p = .0086).Conclusions. Treatment of H. pylori infection was associated with more rapid response to oral iron therapy as compared with the use of iron therapy alone. Such treatment also led to enhanced iron absorption even in those subjects who did not receive oral iron therapy.