Anemia in children with and without Helicobacter pylori infection

BACKGROUND: Iron deficiency is the most common cause of anemia in children. Recently there has been evidence to suggest a relationship between Helicobacter pylori gastritis and iron deficiency anemia. Because both H. pylori infection and iron-deficiency anemia are common in children, we studied any correlation between H. pylori infection and iron-deficiency anemia in children. METHOD: In a case-control study at the Children's Medical Center Hospital, 100 children with H. pylori infection and 109 children without infection according to histology were evaluated. Iron-deficiency anemia was diagnosed when serum ferritin and hemoglobin levels were less than adjusted values for age and sex. RESULTS: There were 111 boys and 98 girls with a median age of 7.1 years. The main symptom was abdominal pain in H. pylori-infected and non-infected patients. Frequency of H. pylori infection in anemic and non-anemic patients was nearly similar (43.9 and 50.4%, respectively). Among patients with H. pylori, 36% had anemia and in patient without H. pylori infection, its frequency was 42.2% (p = 0.59). Among patients with H. pylori, 19% had iron-deficiency anemia and in patients without H. pylori infection, its frequency was 21.1% (p = 0.7). Among patients with H. pylori, the difference between the severity of gastritis in those with anemia and those without anemia was not statistically significant (p = 0.382) and no correlation was found between degree of H. pylori colonization and anemia. CONCLUSIONS: Our results do not support the proposal that H. pylori infection is associated with iron-deficiency anemia in children. Further studies emphasizing the socioeconomic status of children, evaluation of strains of H. pylori, and posttreatment measurement of serum iron and serum ferritin are necessary to show the possible association.