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Doğan Y, Erkan T, Önal Z, Usta M, Doğusoy G, Çokuğraş FÇ, Kutlu T. Lactoferrin levels in the gastric tissue of Helicobacter pylori-positive and -negative patients and its effect on anemia. Mediators Inflamm 2012; 2012:214581. [PMID: 22529520 PMCID: PMC3316978 DOI: 10.1155/2012/214581] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Accepted: 01/10/2012] [Indexed: 02/06/2023] Open
Abstract
AIM To determine gastric tissue lactoferrin (Lf) levels of Helicobacter pylori- (Hp-) positive and -negative patients and its effect on anemia. METHODS Cases in which initial presentation was of abdominal pain and that were Hp-positive at endoscopy were included. Hp-positive cases and -negative controls were divided into two groups. RESULTS The study included 64 cases (average: 10.2 ± 0.4 years, 39 male and 25 female). Lf levels were subsequently studied on 61 cases. 45 (73.8%) of these were Hp-positive, while 16 (22.2%) were Hp-negative. In Hp-positive cases, mean staining percentages and density of glands in the antral mucosa were 45.5 ± 4.7% and 1.9 ± 0.1, respectively. Hp-negative cases showed significantly different values of 17.8 ± 4.5% and 1.3 ± 0.2, respectively. Hemoglobin and serum ferritin values of Hp-positive cases were 12.7 ± 0.2 g/dL and 32.5 ± 2 ng/mL, but these were comparable with Hp-negative cases (12.6 ± 0.1 g/dL and 30.7 ± 4.4 ng/mL). CONCLUSIONS Tissue Lf was significantly higher in Hp-positive cases compared to Hp-negative cases, but no difference was observed between the two groups with regards to hemoglobin and ferritin level. As a result, it is difficult to say that this rise in Lf plays a role in the development of iron deficiency anemia in Hp-positive patients.
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Affiliation(s)
- Yaşar Doğan
- Division of Pediatric Gastroenterology Hepatology and Nutrition, Department of Pediatrics, Cerrahpaşa Medical Faculty, İstanbul University, İstanbul 23119, Turkey.
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Qu XH, Huang XL, Xiong P, Zhu CY, Huang YL, Lu LG, Sun X, Rong L, Zhong L, Sun DY, Lin H, Cai MC, Chen ZW, Hu B, Wu LM, Jiang YB, Yan WL. Does Helicobacter pylori infection play a role in iron deficiency anemia? A meta-analysis. World J Gastroenterol 2010; 16:886-96. [PMID: 20143469 PMCID: PMC2825337 DOI: 10.3748/wjg.v16.i7.886] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AIM: To perform a meta-analysis of observational studies and randomized controlled trials (RCTs) on the association between Helicobacter pylori (H. pylori) and iron deficiency anemia (IDA).
METHODS: A defined search strategy was used to search Medline, Embase, the Cochrane Library, Clinical Trials, Cochrane Central Register of Controlled Trials, Premedline and Healthstar. Odds ratio (OR) was used to evaluate observational epidemiology studies, and weighted mean difference (WMD) was used to demonstrate the difference between control and intervention groups.
RESULTS: Fifteen observational studies and 5 RCTs were identified and used for calculation. The pooled OR for observational studies was 2.22 (95% CI: 1.52-3.24, P < 0.0001). The WMD for hemoglobin (HB) was 4.06 g/L (95% CI: -2.57-10.69, P = 0.01), and the WMD for serum ferritin (SF) was 9.47 μg/L (95% CI: -0.50-19.43, P < 0.0001). Results were heterogeneous for all comparisons.
CONCLUSION: This meta-analysis on observational studies suggests an association between H. pylori and IDA. In RCTs, eradication of H. pylori can improve HB and SF levels but not significantly.
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Santos IS, Minten GC, Valle NCJ, Tuerlinckx GC, Boccio J, Barrado DA, Silva ABD, Pereira GAR. Helicobacter pylori and anemia: a community-based cross-sectional study among adults in Southern Brazil. CAD SAUDE PUBLICA 2009; 25:2653-60. [DOI: 10.1590/s0102-311x2009001200012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2008] [Accepted: 09/30/2009] [Indexed: 01/01/2023] Open
Abstract
To investigate the association between Helicobacter pylori and anemia, a community-based cross-sectional study was conducted among 18-45 year old users of the 31 primary health care units in Pelotas, Southern Brazil. Interviews using a structured questionnaire were carried out in waiting rooms during two work shifts. Anemia (hemoglobin < 11g/dL among pregnant women, < 12g/dL among women and < 13g/dL among men) was diagnosed from capillary blood (HemoCue) and H. pylori by means of a 13C-UBT. Information on socio-demographic, behavioral and biological characteristics was collected. Logistic and linear regression analyses were carried out, taking into account aggregated primary health care units. A total of 1,117 respondents fulfilled the inclusion criteria (losses/refusals: 8.1%). Prevalence of anemia was 20.6% (18.2-23.2%) and of H. pylori, 70.7% (68.0-73.6%). After allowing for age, sex and skin color the odds ratio for anemia among those who were diagnosed H. pylori positive was 0.94 (0.70-1.27). After allowing for sex, skin color, family monthly income, age, and smoking, the reduction in hemoglobin among H. pylori positive respondents was 0.07g/dL (-0.24-0.11; p = 0.4). There is no association between H. pylori and anemia among adults attending primary health care units in Southern Brazil.
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Abstract
The most severe consequence of iron depletion is iron deficiency anemia (IDA), and it is still considered the most common nutrition deficiency worldwide. Although the etiology of IDA is multifaceted, it generally results when the iron demands by the body are not met by iron absorption, regardless of the reason. Individuals with IDA have inadequate intake, impaired absorption or transport, physiologic losses associated with chronological or reproductive age, or chronic blood loss secondary to disease. In adults, IDA can result in a wide variety of adverse outcomes including diminished work or exercise capacity, impaired thermoregulation, immune dysfunction, GI disturbances, and neurocognitive impairment. In addition, IDA concomitant with chronic kidney disease or congestive heart failure can worsen the outcome of both conditions. In this review, the prevalence of IDA related to confounding medical conditions will be described along with its diverse etiologies. Distinguishing IDA from anemia of chronic disease using hematologic measures is reviewed as well. In addition, current diagnostic strategies that are inclusive of clinical presentation, biochemical tests, and differential diagnosis will be outlined, followed by a discussion of treatment modalities and future research recommendations.
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Affiliation(s)
- Susan F Clark
- Virginia Polytechnic Institute and State University, Department of Human Nutrition, Foods and Exercise, Blacksburg, VA 24061, USA.
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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]
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Chen LH, Luo HS. Effects of H pylori therapy on erythrocytic and iron parameters in iron deficiency anemia patients with H pylori-positive chronic gastristis. World J Gastroenterol 2007; 13:5380-3. [PMID: 17879411 PMCID: PMC4171331 DOI: 10.3748/wjg.v13.i40.5380] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To elucidate the influences of H pylori infection on oral iron treatment for iron deficiency anemia (IDA).
METHODS: A total of 86 patients were divided into two groups: group A, receiving ferrous succinate combined with triple therapy for H pylori eradication, and group B (control), treated with ferrous succinate only. During treatment of IDA, dynamic changes in hemoglobin (Hb) level, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), serum iron (SI), and serum ferritin (SF) were compared between the groups.
RESULTS: Hb was slightly higher in group A at d 14 after the start of triple therapy for H pylori eradication(P > 0.05). After the therapy, the increase of Hb in group A became significantly faster than that in group B (P < 0.05). At d 56, the mean Hb in group A returned to the normal level, however, in group B, it was lower than that in group A (P < 0.05) although it had also increased compared with that before oral iron treatment. The MCV and MCH in group A recovered to the normal level, and were much higher than those in group B (P < 0.05) at d 21. In Group B, the MCV and MCH remained at lower than normal levels until d 42 after the start of therapy. And then, they reached a plateau in both groups and the differences disappeared (P > 0.05). The SF in group A was higher than that in group B (P < 0.05) 28 d after the treatment and its improvement was quicker in group A (P < 0.05) , and the difference between the two groups was even more significant (P < 0.01) at d 56. The SI in group A was higher than that in group B (P < 0.05) at d 14 and this persisted until d 56 when the follow-up of this research was finished.
CONCLUSION: Treatment of H pylori can enhance the efficacy of ferrous succinate therapy in IDA patients with H pylori-positive chronic gastritis.
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Affiliation(s)
- Lun-Hua Chen
- Department of Hematology, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China
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Hershko C, Ianculovich M, Souroujon M. A hematologist's view of unexplained iron deficiency anemia in males: impact of Helicobacter pylori eradication. Blood Cells Mol Dis 2006; 38:45-53. [PMID: 17067833 DOI: 10.1016/j.bcmd.2006.09.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2006] [Revised: 09/19/2006] [Accepted: 09/21/2006] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVES Helicobacter pylori infection with, or without coexisting autoimmune gastritis has been implicated in several recent studies as an important cause of IDA in patients with unexplained iron deficiency anemia (IDA). However, the role of H. pylori in the causation of IDA is still unsettled as the vast majority of reported patients were premenopausal women in whom menstrual blood loss was likely the dominant factor determining IDA. DESIGN AND METHODS Prospective study of 44 consecutive male IDA patients referred for hematologic evaluation. Following standard endoscopic studies, all patients were screened for non-bleeding GI conditions including celiac disease, autoimmune gastritis and H. pylori gastritis. All subject with H. pylori infection were offered triple therapy for H. pylori eradication. RESULTS Only 15 patients had a likely source of blood loss identified. The 29 males with "unexplained" IDA were distinguished by their younger age (36+/-20 vs. 57+/-17 years p<0.001), poor initial response to oral iron treatment, and high prevalence of H. pylori infection (25 of 29 vs. 5 of 15 p<0.0001) with (10) or without (15) coexistent autoimmune gastritis. Three had celiac disease. Following H. pylori eradication, all patients achieved normal hemoglobin levels with follow-up periods ranging from 4 to 69 months (38+/-15 months mean+/-1SD). This was accompanied by a significant decrease in H. pylori IgG antibodies and serum gastrin. Sixteen patients discontinued iron treatment, maintaining normal hemoglobin and ferritin and may be considered cured. Remarkably, 4 of the 16 achieved normal hemoglobin without ever having received oral iron after H. pylori eradication. INTERPRETATION AND CONCLUSIONS The favorable long-term clinical results of H. pylori eradication offer strong evidence for a cause-and-effect relation between H. pylori and IDA. Recognition of the respective roles of H. pylori and autoimmune gastritis in the pathogenesis of iron deficiency may have a strong impact on the clinical management of unexplained and refractory iron deficiency anemia.
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Affiliation(s)
- Chaim Hershko
- Department of Hematology, Shaare Zedek Medical Center, Hebrew University Hadassah Med. School, Jerusalem, Israel.
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Abstract
INTRODUCTION The implication of Helicobacter pylori in the onset of anaemia due to iron deficiency, other than the occult bleeding that this germ can provoke, mediated by a peptic ulcer, lymphoma or gastric adenocarcinoma, is still controversial. OBSERVATION A 30 year-old woman was followed-up for 9 years for chronic recurrent anaemia, despite repeated iron therapies. The duodenal-gastro-oesophageal fibroscopy with antral biopsy finally revealed the presence of Helicobacter pylori. Eradication of this infection with antibiotics cured the iron deficiency-induced anaemia and permitted the withdrawal of iron supplementation. DISCUSSION When digestive endoscopic evaluation is indicated in the etiological exploration of iron deficiency anaemia, it must systematically include, together with a duodenal biopsy, an antral biopsy in the search of Helicobacter pylori. In the case of Helicobacter pylori infection, specific therapy must be prescribed so as to assess its efficacy on iron deficiency.
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Affiliation(s)
- Saliou Diop
- Service d'hématologie adultes, Hôpital Necker Enfants malades, Paris
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Salgueiro J, Zubillaga M, Goldman C, Barrado A, Martinez Sarrasague M, Leonardi N, Boccio J. Review article: is there a link between micronutrient malnutrition and Helicobacter pylori infection? Aliment Pharmacol Ther 2004; 20:1029-34. [PMID: 15569104 DOI: 10.1111/j.1365-2036.2004.02265.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Helicobacter pylori causes a chronic gastric infection, which is usually life-long. Many epidemiological studies have shown that this is probably one of the most common bacterial infections throughout the world involving 30% of the population living in developed countries and up to 80-90% of the population in developing regions. Concomitantly, developing regions also have high prevalence of micronutrient malnutrition. In the last few years, some studies have suggested that H. pylori infection may affect the homeostasis of different micronutrients including iron, vitamin B12, folic acid, alpha-tocopherol, vitamin C and beta-carotene. In this article, we discuss the current scientific information of the effect that H. pylori infection may produce on micronutrient malnutrition.
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Affiliation(s)
- J Salgueiro
- Stable Isotope Laboratory Applied to Biology and Medicine, Physics Department, School of Pharmacy and Biochemistry, University of Buenos Aires, Ciudad de Buenos Aires, Argentina
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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; 36:455-460. [PMID: 15285524 DOI: 10.1016/j.dld.2004.02.008] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.9] [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.
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Affiliation(s)
- C Ciacci
- Department of Clinical and Experimental Medicine, Gastrointestinal Unit, Federico II University of Naples, via Pansini 5, 80131 Naples, Italy.
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Demir H, Saltik IN, Yüce A, Ozen H, Gürakan F, Koçak N. Is there any relation between Helicobacter pylori infection and iron deficiency anemia in children with celiac disease? Helicobacter 2004; 9:284. [PMID: 15165266 DOI: 10.1111/j.1083-4389.2004.00231.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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Nahon S, Lahmek P, Massard J, Lesgourgues B, Mariaud de Serre N, Traissac L, Bodiguel V, Adotti F, Delas N. Helicobacter pylori-associated chronic gastritis and unexplained iron deficiency anemia: a reliable association? Helicobacter 2003; 8:573-7. [PMID: 14632670 DOI: 10.1111/j.1523-5378.2003.00184.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND AIM About 35% of iron deficiency anemia cases remain unexplained after a gastrointestinal evaluation. An association between Helicobacter pylori and iron malabsorption has been suggested. The aim of this study was to determine whether H. pylori-associated chronic gastritis is linked to unexplained iron deficiency anemia in adults. METHODS From 1996 to 2001, we identified 105 patients with unexplained iron deficiency anemia after upper endoscopy, colonoscopy, small bowel radiographic examination and duodenal biopsies. Two biopsies were obtained from the gastric antrum and two from the corpus of each patient. Gastritis status was described according to the Sydney System and H. pylori infection was assessed by an immunohistochemical test on biopsy specimens. This group was compared to a control group matched for sex and age. RESULTS There were 76 women and 29 men (mean age 57.4 +/- 21.4 years) examined in the study. A H. pylori-associated chronic gastritis was identified in 63 cases (60%) vs. 45 cases (43%) cases in the control group (p <.01). Atrophic gastritis was significantly associated with iron deficiency anemia compared with the control group [16 (15%) vs. 6 (6%); p <.03]. In the unexplained iron deficiency anemia group, (1) patients with chronic gastritis were significantly younger (52 +/- 22 vs. 64 +/- 20 years; p <.005), and (2) chronic gastritis was not linked to sex [sex ratio (male/female): 0.5 vs. 0.34, p =.34]. The prevalence of H. pylori infection was similar between premenopausal and postmenopausal women [28 (27%) vs. 26 (25%); p =.7] with iron deficiency anemia. CONCLUSION H. pylori infection and chronic gastritis, especially atrophic gastritis, are significantly associated with unexplained iron deficiency anemia. Relationships between H. pylori-associated chronic gastritis and unexplained iron deficiency anemia should be considered.
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Affiliation(s)
- Stéphane Nahon
- Service de Gastroentérologie, Centre Hospitalier Intercommunal le Raincy-Montfermeil, Montfermeil, France
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Sörberg M, Nyrén O, Granström M. Unexpected decrease with age of Helicobacter pylori seroprevalence among Swedish blood donors. J Clin Microbiol 2003; 41:4038-42. [PMID: 12958222 PMCID: PMC193826 DOI: 10.1128/jcm.41.9.4038-4042.2003] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Blood donors are often used as proxies for the general population in studies of Helicobacter pylori epidemiology. Our aim was to test if the age-specific seroprevalence rates among blood donors match with the corresponding rates in a random population sample. This descriptive study was based on sera obtained from 3,502 blood donors representing all Swedish counties and cities. An age-stratified random population sample of 1,030 from Stockholm County served as comparison. Sera were analyzed by an in-house enzyme-linked immunosorbent assay for H. pylori immunoglobulin G antibodies. In the population sample, we found the expected increase with age in the seroprevalence of H. pylori infection. This was true also among young blood donors, while the prevalence-by-age curve showed a deflection downward among blood donors who are >/= 50 years of age. In this age group, the probability of being seropositive was reduced by 73% (95% confidence interval [CI], 63 to 81%) relative to the population sample. Overall, the adjusted odds ratio for H. pylori seropositivity among blood donors was decreased by 43% (95% CI, 28 to 55%). Thus, it appears that blood donors who are H. pylori seropositive selectively disappear from the blood donor cohort. We speculate that H. pylori-seropositive blood donors may tolerate repeated bleedings less well than do noninfected individuals and/or that the general well-being among those who are infected may be somewhat impaired. Our unexpected observation indicates that blood donors may be less suitable as proxies for the general population in analytic studies of H. pylori infection and that the underlying cause needs further study.
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Affiliation(s)
- M Sörberg
- Infectious Diseases Unit, Department of Medicine, MTC, Karolinska Hospital, Karolinska Institutet, Stockholm, Sweden
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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.
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Affiliation(s)
- B Annibale
- Department of Digestive and Liver Disease, II Medical School, Sant'Andrea Hospital, University La Sapienza, Rome, Italy.
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