AL-AZHAR ASSIUT MEDICAL JOURNAL AAMJ ,VOL 13 , NO , JULY 2015 THE RELATIONSHIP BETWEEN HELICOBACTER PYLORI AND IRON DEFICIENCY ANEMIA Mohamed A Saleh1and Essam A Hassan2 1-Internal medicine department, National Hepatology and Tropical medicine Institute, Cairo 2-Tropical medicine department, Faculty of medicine, fayoum University ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ ABSTRACT Background: Helicobacter pylori (H pylori) is a spiral bacterium and has been suggested as a cause of iron deficiency, also, gastrointestinal blood loss due to peptic ulcer disease was found to occur with H pylori infection The aim of this study was to assess the association between H pylori infection and iron deficiency Materials and methods: The study was conducted on 120 subjects patients divided into 70 patient with iron deficiency anemia and 50 healthy subjects with normal hemoglobin as a control All patients had recent normal upper gastrointestinal endoscopy within the previous months Blood sample was withdrawn for measurement of complete blood picture, serum iron, serum ferritin, and a stool sample was collected and examined for helicobacter pylori Ag detection Results:H Pyloriprevalence showed no statistically significant difference between patient and control group 46 (65.7%), 32 (64%) respectively (P=0.722).Hemoglobin concentration, MCV, serum iron and serum ferritin showed significant difference between patient and control group (P0.05) Conclusion: The results of this study showed no significant association between H pylori infection and iron deficiency Anemia INTRODUCTION Helicobacter pylori is a highly prevalent gramnegative urease producing organisms worldwide affecting more than half of the global population, the infection showed a variable prevalence in different age groups, and socioeconomic standards (1) Also a wide prevalence range was seen in different geographical region from 82% in low socioeconomic developing countries to about 30% in developed countries (2).More than 60% of developing countries children are infected with H Pylori (3) Dyspepsia, recurrent abdominal pain, peptic ulcerations, gastric lymphoma and other gastrointestinal disorders were associated with H pylori infection Moreover extra gastrointestinal disorders as iron deficiency anemia, idiopathic thrombocytopenic purpura and lipid profile disorders showed an association with H Pylori infection (4) Iron deficiency anemia (IDA) is considered the most common cause of anemia worldwide (5) Lack of dietary iron was defined as the main cause for iron deficiency anemia in children, and menstrual bleeding in premenopausal females, while chronic blood loss due to gastrointestinal bleeding was found to be the most common cause in adult males (6) In 1991, it was the first time to demonstrate the relationship between H pylori and IDA, also, many recent studies proved that in patients with IDA not only, iron absorption is improved after H.pylori eradication therapy but also, iron administration combined with H pylori eradication was more effective than iron administration alone (7) The underlying mechanisms of association between IDA and H pylori are not fully understood yet, but it may be due to H pylori competing for dietary iron, other suggested mechanisms include decreased gastric HCL secretion and achlorhydria which reduce iron absorption (8) Overt or occult gastrointestinal bleeding is considered to be the major reason for iron deficiency, and practical guidelines ensures on performing upper and lower gastrointestinal endoscopy in evaluating patients with iron deficiency anemia (9) It was also found that, H Pylori infection is a direct cause for peptic ulcer occurrence, which subsequently may lead to upper gastrointestinal blood loss, and it is controversial if H Pylori infection can cause iron deficiency anemia without peptic ulcer disease (10) Most of the studies that demonstrate the association between H Pylori infection and iron deficiency anemia, did not exclude the presence of peptic ulceration as a cause of anemia (11) The aim of this study was to evaluate the association between H pylori infection and iron deficiency anemia PATIENTS AND METHODS This study was conducted in the outpatient clinic; National Hepatology and Tropical Medicine research Institute (NHTMRI) in Cairo, Egypt 229 | P a g e Mohamed A Saleh1and Essam A Hassan2 This study was conducted on 120 male patients with recentnormal upper GI endoscopy Subjects with history of chronic illness, anemia due to causes other than iron deficiency, history of GI bleeding, history of upper or lower GI endoscopy lesions, positive occult blood in stool, history of gastric or bariatric surgery, malignancy, chemotherapy, patients on iron therapy or medication for H pylori were excluded All participants provided and approved an informed consent This study subjects were divided according to hemoglobin level into 70 patients with iron deficiency anemia, and 50 patients with normal hemoglobin level as a control group According to World Health Organization (WHO) criteria iron deficiency anemia was defined as hemoglobin level less than 13 g/dl in men and 12 g/dl in women, serum iron level less than 65μg/dLand ferritin less than 18ng/ml Blood samples were taken into EDTA vacutainers for CBC assay, and Palin tubes for serum iron and ferritin assay Complete blood count (CBC) was measured using cell dyne-3700 (Abbott Diagnostics, Dallas, USA) Serum iron was assessed by using of Cobas-C311 (Roch Diagnostics, Mannheim, Germany) Serum ferritin was level was measured using Architect 2000 system (Abbott Diagnostics, Dallas, USA) Stool sampleswere collected from all subjects and tested for the H pylori antigen using the H pylori Ag test statistical analysis by using SPSS-22 software, the distribution of quantitative measurements were shown in mean ± SD (Standard Deviation), chi square and Mann-Whitny tests were also used, value below 0.05 was used as statistically significant in all tests RESULTS This study was conducted on 120 subjects divided according to hemoglobin level into 70 patients with iron deficiency anemia (32 men and 38 women) and 50 subject with normal hemoglobin level as a control group(26 men and 24 women), the mean ages in the patients and control group were 40.5±10.2 and 38.3±10.1 years respectively with (P=0.135) The prevalence of H Pylori showed no statistically significance difference when compared in patient (65.7%) and control group (64%) (P=0.722) (Figure 1) There was a statistically significant decrease in patient group when compared with the control group regarding hemoglobin level (9.2±1.7vs AAMJ ,VOL 13 , NO , JULY 2015 13.7±0.88g/dL; P