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Bashir Ahmed Khuhro
Mohsin Ali
Riaz Hussain Khokhar
Khawar Hussain
Nasrullah Aamer




OBJECTIVE “Helicobacter pylori (H. pylori) infection is the most common chronic infection. The aim of this cross-sectional study was to determine the association between iron profile, serum iron, ferritin level, and total serum iron binding capacity (TIBC) in adults and adolescents with positive H. pylori infection. 

METHODOLOGY This study was conducted this case control study in the Department of Medicine, PUMHSW Nawabshah, Shaheed Benazirabad Sindh Pakistan from April 2022 to March 2023. A total of 200 patients of both sexes with seropositive H. pylori confirmed by the presence of stool specific antigen (HpSAg) or positive antibodies to Helicobacter pylori in the blood were enrolled as group A. Another 200 subjects with negative H. pylori were recruited to adjust for age and sex and designated as group B, aged 18 to 60 years of both sexes.Blood was drawn for hematocrit (Hct), hemoglobin (Hb), and iron profile. Data were noted in a predesigned, prestructured proforma, and confidentiality was maintained. All data variables were analyzed using SPSS 22.0 (USA).

RESULTS Out of 256 subjects, 128 were in case group and 128 in control group. The mean age of case group was 37.8906 ± 11.69510 years and for control it was 37.5000 + 11.56018. Regarding the gender the 60 (46.9%) were male and 56 (43.8%) were female in case group. In study the mean iron level was 58.9530 + 24.77736 in H. pylori participants as and those who were negative H. pylori their mean serum iron was 68.1180 ± 18.06080; p-value: <0.001. Serum ferritin level was 112.7328± 105.16863 in H. pylori positive group as compared to control group that was 208.5980± 114.04281ng/dL; p-value: <0.001. The mean total iron-binding capacity was 331.7559 ± 67.79927 ug/dl.

 CONCLUSIONS The study results support a positive association between H. pylori and a low serum iron profile. Therefore, we recommended that in H. pylori positive patients should be investigated for iron profile.

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1. Hathroubi S, Servetas SL, Windham I, Merrell DS. Helicobacter pylori biofilm formation and its potential role in pathogenesis. Microbiol. Mol. Biol. Rev. 2018; 82: e00001– e00018.
2. Kouitcheu MLB, Noudjeu MI, Leundji H. Potential risk factors and prevalence of Helicobacter pylori infection among adult patients with dyspepsia symptoms in Cameroon. BMC Infect. Dis. 2018; 18: 278.
3. Moretti E, Figura N, Collodel G, Ponzetto A. Can helicobacter pylori infection influence human reproduction? World J Gastroenterol. 2014;20(19):5567-74.
4. Muhsen K, Cohen D. Helicobacter pylori infection and iron stores: a systematic review and meta-analysis. Helicobacter. 2008; 13: 323– 40.
5. Fernández-Bañares F, Monzón H, Forné M. A short review of malabsorption and anemia. World J. Gastroenterol. 2009; 15: 4644– 52
6. Toh BH, van Driel IR, Gleeson PA. Pernicious anemia. N. Engl. J. Med. 1997; 337: 1441– 8.,
7. Eyoum Bille BB, Kouitcheu Mabeku LB. Relationship between active Helicobacter pylori infection and anemia, iron deficiency, iron deficiency anemia: A cross-sectional study in a sub-Saharan setting. JGH Open. 2022 Jul 15;6(8):554-568. doi: 10.1002/jgh3.12787.
8. Celiński K, Kurzeja-Mirosław A, Słomka M, Cichoz-Lach H, Madro A, Kasztelan-Szczerbińska B: The effects of environmental factors on the prevalence of Helicobacter pylori infection in inhabitants of Lublin Province. Ann Agric Environ Med. 2006, 13:185-91.
9. Hudak L, Jaraisy A, Haj S, Muhsen K. An updated systematic review and meta-analysis on the association between Helicobacter pylori infection and iron deficiency anemia. Helicobacter 2017; 22(1):1-5
10. Kato S, Gold BD, Kato A. The Resolution of Severe Iron-Deficiency Anemia After Successful Eradication of Helicobacter pylori in Teenagers. JPGN Rep. 2022 Aug 16;3(3): e238. doi: 10.1097/PG9.0000000000000238.
11. 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: 455-60.
12. Ashorn M, Acid and iron- disturbances related to Helicobacter pylori infection. J Pediatr Gastrointerol Nutr 2004; 38: 137-39.
13. Berg G, Bode G, Blettner M, Boeing H, Brenner H. Helicobacter pylori infection and serum ferritin: a population-based study among 1806 adults in Germany. Am J Gastroenterol 2001; 96:1014-18.
14. Seo JK, Ko JS, Choi KD. Serum ferritin and Helicobacter pylori infection in children: a sero-epidemiologic study in Korea. J Gastroenterol Hepatol 2002; 17:754-57.
15. Milman N, Rosenstock S, Andersen L, Jorgensen T, Bonnevie O. Serum ferritin, hemoglobin, and Helicobacter pylori infection: a seroepidemiologic survey comprising 2794 Danish adults. Gastroenterology 1998; 115: 268-74.
16. Kishore G, Ejaz M, Kumar J, et al. (September 13, 2021) Association Between Helicobacter pylori Infection and Serum Iron Profile. Cureus 13(9): e17925. DOI 10.7759/cureus.17925
17. Kumar S, Ali A, Kumar D, Mal N, Tabassum U, Hingorjo B. Serum ferritin and iron profile in helicobacter pylori infected young adult male reporting at a tertiary care hospital. Professional Med J 2019; 26(6):896-901. DOI: 10.29309/TPMJ/2019.26.05.3591
18. Collett JA, Burt MJ, Frampton CM, Yeo KH, Champma TM, Buttimore RC, et al. Seroprevalence of Helicobacter pylori in the adult population of Christchurch; Risk factors and relationship to dyspeptic symptoms and iron studies. N Z Med J 1999; 112: 292-95.
19. Nohario SA, Siyal BA, Memon MA, Nohri AR. Frequency of Anemia and Iron Deficiency Anemia in Patients with Helicobacter Pylori Infection: A Cross-Sectional Study. Pakistan Journal of Medical & Health Sciences. 2023 Mar 2;17(01):482-.
20. Sadiq A, Hameed JA, Khan MR, Mushtaq M, Yasmin R, Khan MS. Frequency of Iron Deficiency Anemia (IDA) Among Patients with Helicobacter Pylori Infection. Pakistan Journal of Medical & Health Sciences. 2022 Dec 20;16(10):885-.
21. Shah GM, Memon WR. Effects of Helicobacter Pylori Infection on Serum Ferritin Level in Population of Shaheed Benazirabad. PJMHS 2020 ;37(5.11):33-11.
22. Rohr, M., Brandenburg, V. & Brunner-La Rocca, HP. How to diagnose iron deficiency in chronic disease: A review of current methods and potential marker for the outcome. Eur J Med Res 28, 15 (2023). https://doi.org/10.1186/s40001-022-00922-6
23. Faruqi A, Mukkamalla SKR. Iron Binding Capacity. [updated 2023 Jan 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. Available from: https://pubmed.ncbi.nlm.nih.gov/32644545/
24. Al-Naseem A, Sallam A, Choudhury S, Thachil J. Iron deficiency without anaemia: a diagnosis that matters. Clin Med 2021; 21:107–13.DOI: 10.7861/clinmed.2020-0582
25. Sohail S, Khalid-ur-rehman TU. Red Blood Cell Count, Hemoglobin and Red Blood Cell Indices in H Pylori Infected Cases. Group.; 2014;18:12.
26. Rahat A, Kamani L. Frequency of iron deficiency anemia (IDA) among patients with Helicobacter pylori infection. Pak J Med Sci. 2021 May-Jun;37(3):776-781. doi: 10.12669/pjms.37.3.3944.
27. Yasir S, Moin F and Akhtar S M.Frequency of Helicobacter Pylori Infection on Histopathology in Patients with Dyspepsia. American Journal of Clinical Medicine Research, 2014; 2(3): 53- 56
28. Zamani A, Shariat M, Oloomi YZ, Bahremand S, Akbari AP, Dejakam A. Relationship between Helicobacter pylori infection and serum ferritin level in primary school children in Tehran-Iran. Acta medica Iranica. 2011;49(5):314.
29. Miernyk K, Bruden D, Zanis C, et al.: The effect of Helicobacter pylori infection on iron stores and iron deficiency in urban Alaska Native adults. Helicobacter. 2013, 18:222-8. 10.1111/hel.12036
30. Rahman A, Raihan AS, Ahmed DS, Karim ME, Saeed A, Siddique AR, Sadat SA. Association between Helicobacter pylori infection and iron deficiency anemia: a cross sectional study. Journal of Bangladesh College of Physicians and Surgeons. 2020 Feb 27;38(2):68-78.
31. Peach HG, Bath NE, Farish SJ. Helicobacter pylori infection: An added stressor on iron status of women in the community. Med J Aust 1998; 169:188-90.
32. LIN Xi, WU Bin. Chinese journal of child health care 2005;3: 436-39.
33. Seo JK, Ko JS, Choi KD. Serum ferritin and Helicobacter pylori infection in children: a sero-epidemiologic study in Korea. J Gastroenterol Hepatol 2002;17: 754-57.
34. 50. Zamani A, Yazdi ZY, Bahremand S, Ashagh PA, Dejakam A. Journal of Pakistan Medical Association 2011;61: 658-61Choi JW. Does Helicobacter pylori infection relate to iron deficiency anaemia in prepubescent children under 12 years of age? Acta Paediatr 2003; 92:970-72.
35. Choe YH, Kim SK, Hong YC. The relation between Helicobacter pylori infection and iron deficiency: a seroprevalence study in 937 pubescent children. Arch Dis Child 2003; 88: 178.
36. Afifi RA, ALI DK, Shaheen A. A localized case-control study of extra gastric manifestation of Helicobacter pylori infection in children. Indian J Paediatric 2011; 78:418-22.
37. Eshraghian A. Epidemiology of Helicobacter pylori infection among the healthy population in Iran and countries of the Eastern Mediterranean Region: a systematic review of prevalence and risk factors. World J Gastroenterol. 2014 Dec 14;20(46):17618-25. doi: 10.3748/wjg. v20.i46.17618.
38. Hsiang-Yao Shih, Fu-Chen Kuo, Sophie S. W. Wang, Yi-Chang Liu, Meng-Chieh Wu, Yang-Pei, et al. Helicobacter pylori infection and anemia in taiwanese adults. Gastroenterology Research and Practice 2013; 2(1):211-215.
39. Cardenas VM, Mulla ZD, Ortiz M, Graham DY: Iron deficiency and Helicobacter pylori infection in the United States. Am J Epidemiol. 2006, 163:127-34. 10.1093/aje/kwj018
40. Darvishi M, Ziari K, Mohebbi H, Alizadeh K: Association between iron deficiency anemia and Helicobacter pylori infection among children under six years in Iran. Acta Med Iran. 2015, 53:220-4.
41. Qu XH, Huang XL, Xiong P, Zhu CY, Huang YL, Lu LG, et al. Does Helicobacter pylori infection play a role in iron deficiency anemia? A meta-analysis. World J Gastroenterol. 2010 Feb 21;16(7):886-96. doi: 10.3748/wjg. v16.i7.886.
42. Mladenova I, Durazzo M. Transmission of Helicobacter pylori. E dietologica. 2018;64(3):251-4.
43. Webb PM, Knight T, Greaves S, Wilson A, Newell DG, Elder J, Forman D. Relation between infection with Helicobacter pylori and living conditions in childhood: Evidence for person-to-person transmission in early life. Bmj. 1994; 308(6931):750-3.
44. Mulayamkuzhiyil Saju J, Mandal N, Kham N I, et al. (September 13, 2022) Is Helicobacter Pylori a Reason for Unexplained Iron Deficiency Anemia: A Systematic Review. Cureus 14(9): e29112. doi:10.7759/cureus.29112
45. Xia, W., Zhang, X., Wang, J., Sun, C., & Wu, L. (2012). Survey of anaemia and Helicobacter pylori infection in adolescent girls in Suihua, China and enhancement of iron intervention effects by H. pylori eradication. British Journal of Nutrition, 108(2), 357-362. doi:10.1017/S0007114511005666
46. DiGirolamo AM, Perry GS, Gold BD, Parkinson A, Provost EM, Parvanta I, Grummer-Strawn LM. Helicobacter pylori, anemia, and iron deficiency: relationships explored among Alaska native children. Pediatr Infect Dis J. 2007 Oct;26(10):927-34. doi: 10.1097/INF.0b013e31812e52cd.
47. Hou B, Zhang M, Liu M, Dai W, Lin Y, Li Y, Gong M, Wang G. Association of active Helicobacter pylori infection and anemia in elderly males. BMC infectious diseases. 2019 Dec; 19(1):1-9.
48. Chen LH, Luo HS. Effects of H pylori therapy on erythrocytic and iron parameters in iron deficiency anemia patients with H pylori-positive chronic gastritis. World J Gastroenterol 2007; 13(40): 5380-5383

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