Helicobacter Pylori and Iron Deficiency Anemia in Children: Case Series and Review of Literature 

Authors

  • Francesca Penagini Department of Paediatrics, Ospedale dei Bambini V. Buzzi, University of Milan, Italy
  • Dario Dilillo Department of Paediatrics, Ospedale dei Bambini V. Buzzi, University of Milan, Italy
  • Matteo Torcoletti Department of Paediatrics, Luigi Sacco Hospital, University of Milan, Italy
  • Silvia Mauri Department of Paediatrics, Luigi Sacco Hospital, University of Milan, Italy
  • Paolo Fociani Department of Pathology, Luigi Sacco Hospital, University of Milan, Italy
  • Gian Vincenzo Zuccotti Department of Paediatrics, Ospedale dei Bambini V. Buzzi, University of Milan, Italy

DOI:

https://doi.org/10.12974/2311-8687.2014.02.02.3

Keywords:

Helicobacter pylori, iron deficiency anemia, gastritis, children.

Abstract

Helicobacter pylori (H. pylori) infection has been described as a possible cause of refractory iron deficiency anemia (IDA) in children. Nevertheless, the relationship between H. pylori infection and IDA in children remains an area of controversy due to the contrasting data in literature. We report a case series of two children who presented with IDA refractory to iron treatment, which reversed only after eradication of H. pylori infection, supporting the causal role of this bacterium in pathogenesis of IDA. In both cases H. pylori presented a high antimicrobial resistance, raising the issue on the importance of considering geographical susceptibility of H. pylori strains when starting empirical treatment and the importance of performing antimicrobial susceptibility testings, in particular if standard empirical therapy fails. The present review gives a complete overview of the literature regarding the relationship between H. pylori and IDA in children, explains the possible pathogenetic mechanisms involved in H. pylori-related IDA and addresses the issue of the high antimicrobial resistance often encountered in H. pylori infection in children. 

References

Homan M, Hojsak I, Kolacek S. Helicobacter pylori in pediatrics. Helicobacter 2012; 17: 43-8. http://dx.doi.org/10.1111/j.1523-5378.2012.00982.x DOI: https://doi.org/10.1111/j.1523-5378.2012.00982.x

Kalach N, Bontems P, Koletzko S, Mourad- Baars P, Shcherbakov P, Celinska- Cedro D, et al. Frequency and risk factors of gastric and duodenal ulcers or erosions in children: a prospective 1-month European multicenter study. Eur J Gastroenterol Hepatol 2010; 22: 1174-81. http://dx.doi.org/10.1097/MEG.0b013e32833d36de DOI: https://doi.org/10.1097/MEG.0b013e32833d36de

Rowland M, Daly L, Vaughan M, Higgins A, Bourke B, Drumm B. Age-specific incidence of Helicobacter pylori. Gastroenterology 2006; 130: 65-72. http://dx.doi.org/10.1053/j.gastro.2005.11.004 DOI: https://doi.org/10.1053/j.gastro.2005.11.004

Goodman KJ, O' Rourke K, Day RS, Wang C, Nurgalieva Z, Phillips CV, et al. Dynamics of Helicobacter pylori infection in a US-Mexico cohort during the first two years of life. Int J Epidemiol 2005; 34: 1348-55. http://dx.doi.org/10.1093/ije/dyi152 DOI: https://doi.org/10.1093/ije/dyi152

Azevedo NF, Huntington J, Goodman KJ. The epidemiology of Helicobacter pylori and public health implications. Helicobacter 2009; 14: 1-7. http://dx.doi.org/10.1111/j.1523-5378.2009.00703.x DOI: https://doi.org/10.1111/j.1523-5378.2009.00703.x

Koletzko SI, Jones NL, Goodman KJ, Gold B, Rowland M, Cadranel S, et al. Evidence-based guidelines from ESPGHAN and NASPGHAN for Helicobacter pylori infection in children. J Pediatr Gastroenterol Nutr 2011; 53: 230-43. DOI: https://doi.org/10.1097/MPG.0b013e3182227e90

Choe YH, Kim SK, Son BK, Lee DH, Hong YC, Pai SH. Randomized placebo-controlled trial of Helicobacter pylori eradication for iron-deficiency anemia in preadolescent children and adolescents. Helicobacter 1999; 4: 135-9. http://dx.doi.org/10.1046/j.1523-5378.1999.98066.x DOI: https://doi.org/10.1046/j.1523-5378.1999.98066.x

Kurekci AE, Atay AA, Sarici SU, Yesilkaya E, Senses Z, Okutan V, et al. Is there a relationship between childhood Helicobacter pylori infection and iron deficiency anemia? J Trop Pediatr 2005; 51: 166-9. http://dx.doi.org/10.1093/tropej/fmi015 DOI: https://doi.org/10.1093/tropej/fmi015

Perez-Perez GI and Israel DA. Role of iron in Helicobacter pylori: its influence in outer membrane protein expression and in pathogenicity. Eur J Gastr Hepatol 2000; 12: 1263-65. http://dx.doi.org/10.1097/00042737-200012120-00001 DOI: https://doi.org/10.1097/00042737-200012120-00001

Yip R, Limburg PJ, Ahlquist DA, Carpenter HA, O'Neill A, Kruse D, et al. Pervasive occult bleeding in an Alaska native population with prevalent iron deficiency. Role of Helicobacter pylori gastritis. JAMA 1997; 277: 1135-9. http://dx.doi.org/10.1001/jama.1997.03540380049030 DOI: https://doi.org/10.1001/jama.277.14.1135

Gessner BD, Baggett HC, Muth PT, Dunaway E, Gold BD, Feng Z, et al. A controlled, household-randomized, openlabel trial of the effect that treatment of Helicobacter pylori infection has on iron deficiency in children in rural Alaska. J Infect Dis 2006; 193: 537-46. http://dx.doi.org/10.1086/499604 DOI: https://doi.org/10.1086/499604

Fagan RP, Dunaway CE, Bruden DL, Parkinson AJ, Gessner BD. Controlled, Household-Randomized, Open-Label Trial of Effect of Treatment of Helicobacter pylori Infection on Iron Deficiency among Children in Rural Alaska: Results at 40 months. J Infect Dis 2009; 199: 652-60. http://dx.doi.org/10.1086/596659 DOI: https://doi.org/10.1086/596659

Sarker SA, Mahmud H, Davidsson L, Alam NH, Ahmed T, Alam N, et al. Causal relationship of Helicobacter pylori with iron-deficiency anemia or failure of iron supplementation in children. Gastroenterology 2008; 135: 1534-42. http://dx.doi.org/10.1053/j.gastro.2008.07.030 DOI: https://doi.org/10.1053/j.gastro.2008.07.030

Afifi RA, Ali DK, Shaheen IA. A localized case-control study of extra-gastric manifestations of Helicobacter pylori infection in children. Indian J Pediatr 2011; 78: 418-22. http://dx.doi.org/10.1007/s12098-010-0308-6 DOI: https://doi.org/10.1007/s12098-010-0308-6

Cardenas VM, Prieto-Jimenez CA, Mulla ZD, Rivera JO, Dominguez DC, Graham DY, et al. Helicobacter pylori eradication and change in markers of iron stores among noniron- deficient children in El Paso, Texas: an etiologic intervention study. J Pediatr Gatroenterol Nutr 2011; 52: 326- 32. http://dx.doi.org/10.1097/MPG.0b013e3182054123 DOI: https://doi.org/10.1097/MPG.0b013e3182054123

Dufour C, Brisigotti M, Fabretti G, Luxardo P, Mori PG, Barabino. A Helicobacter pylori gastric infection and sideropenic refractory anemia. J Pediatr Gatroenterol Nutr 1993; 17: 225-7. http://dx.doi.org/10.1097/00005176-199308000-00018 DOI: https://doi.org/10.1097/00005176-199308000-00018

Carnicier J, Badia R, Argemì J. Helicobacter pylori gastritis and sideropenic refractory anemia. J Pediatr Gatroenterol Nutr 1997; 25: 441. http://dx.doi.org/10.1097/00005176-199710000-00017 DOI: https://doi.org/10.1097/00005176-199710000-00017

Marignani M, Angeletti S, Bordi C, Malagnino F, Mancino C, Delle Fave G, et al. Reversal of long-standing iron deficiency anemia after eradication of Helicobacter pylori infection. Scand J Gastroenterol 1997; 32: 617-22. http://dx.doi.org/10.3109/00365529709025109 DOI: https://doi.org/10.3109/00365529709025109

Barabino A, Dufour C, Marino CE, Claudiani F, De Alessandri A. Unexplained refractory anemia associated with Helicobacter pylori gastric infection in children: further clinical evidence. J Pediatr Gatroenterol Nutr 1999; 28: 116-9. http://dx.doi.org/10.1097/00005176-199901000-00027 DOI: https://doi.org/10.1097/00005176-199901000-00027

Konno M, Muraoka S, Takahashi M, Imai T. Iron deficiency anemia associated with Helicobacter pylori gastritis. J Pediatr Gatroenterol Nutr 2000; 31: 52-6. http://dx.doi.org/10.1097/00005176-200007000-00012 DOI: https://doi.org/10.1097/00005176-200007000-00012

Ashorn M, Ruuska T, Makipernaa. A Helicobacter pylori and iron deficiency anaemia in children. Scand J Gastroenterol 2001; 36: 701-5. http://dx.doi.org/10.1080/003655201300191950 DOI: https://doi.org/10.1080/003655201300191950

Santalha MF, Costa E, Miguel N, Vizcaino R, Barbot J, Pereira F Iron deficiency anemia due to lymphocytic Gastritis with Helicobacter pylori infection in childhood: case report. J Pediatr Hematol Oncol 2013; 35: 321-2. http://dx.doi.org/10.1097/MPH.0b013e318286d129 DOI: https://doi.org/10.1097/MPH.0b013e318286d129

Choe YH, Lee JE, Kim SK. Effect of Helicobacter pylori eradication on sideropenic refractory anemia in adolescent girls with Helicobacter pylori infection. Acta Pediatr 2000; 89: 154-7. http://dx.doi.org/10.1111/j.1651-2227.2000.tb01208.x DOI: https://doi.org/10.1111/j.1651-2227.2000.tb01208.x

Choe JH, Kwon YS, Jung MK, Kang SK, Hwang TS, Hong YC. Helicobacter pylori-associated iron deficiency anemia in adolescent female athletes. J Pediatr 2001; 139: 100-4. http://dx.doi.org/10.1067/mpd.2001.114700 DOI: https://doi.org/10.1067/mpd.2001.114700

Mégraud F, Occhialini A, Doermann HP. Resistance of Helicobacter pylori to macrolides and nitroimidazole compounds. The current situation. J Physiol Pharmacol 1997; 48: 25-38.

Kalach N, Benhamou PH, Campeotto F, Bergeret M, Dupont C, Raymond J. Clarithromycin resistance and eradication of Helicobacter pylori in children. Antimicrobial Agents Chemother 2001; 45: 2134-5. http://dx.doi.org/10.1128/AAC.45.7.2134-2135.2001 DOI: https://doi.org/10.1128/AAC.45.7.2134-2135.2001

Mégraud F. H. pylori antibiotic resistance: prevalence, importance, and advances in testing. Gut 2004; 53: 1374-84. http://dx.doi.org/10.1136/gut.2003.022111 DOI: https://doi.org/10.1136/gut.2003.022111

Koletzko S, Richy F, Bontems P, Crone J, Kalach N, Monteiro ML, et al. Prospective multicentre study on antibiotic resistance of Helicobacter pylori strains obtained from children living in Europe. Gut 2006; 55: 1711-6. http://dx.doi.org/10.1136/gut.2006.091272 DOI: https://doi.org/10.1136/gut.2006.091272

Ogata SK, Oritz Godoy AP, da Silva Patricio FR, Kawakami E. High Helicobacter pylori resistance to metronidazole and clarithromycin in Brazilian children and adolescents. J Pediatr Gastroenterol Nutr 2013; 56: 645-8. http://dx.doi.org/10.1097/MPG.0b013e31828b3669 DOI: https://doi.org/10.1097/MPG.0b013e31828b3669

Prazeres Magalhaes P, De Magalhaes Queiroz DM, Campos Barbosa DV, Aguir Rocha G, Nogueira Mendes E, Santos A, et al. Helicobacter pylori primary resistance to metronidazole and clarithromycin in Brazil. Antimicrobial Agents Chemother 2002; 46: 2021-3. http://dx.doi.org/10.1128/AAC.46.6.2021-2023.2002 DOI: https://doi.org/10.1128/AAC.46.6.2021-2023.2002

Godoy AP, Ribeiro ML, Benvengo YH, Vitiello L, Miranda Mde C, Mendonca S, et al. Analysis of antimicrobial susceptibility and virulence factors in Helicobacter pylori clinical isolates. BMC Gastroenterology 2003; 3: 20. http://dx.doi.org/10.1186/1471-230X-3-20 DOI: https://doi.org/10.1186/1471-230X-3-20

Cuadrado-Lavin A, Salcines-Caviedes JR, Carrascosa MF, Mellado P, Monteagudo I, Llorca J, et al. Antimicrobial susceptibility of Helicobacter pylori to six antibiotics currently used in Spain. J Antimicrob Chemother 2012; 67: 170-3. http://dx.doi.org/10.1093/jac/dkr410 DOI: https://doi.org/10.1093/jac/dkr410

Miendje Deyi VY, Bontems P, Vanderplas J, De Koster E, Ntounda R, Van den Borre C, et al. Multicentre survey of routine determinations of resistance of Helicobacter pylori to antimicrobials over last 20 years (1990-2009) in Belgium. J Clin Microbiol 2011; 49: 2200-9. http://dx.doi.org/10.1128/JCM.02642-10 DOI: https://doi.org/10.1128/JCM.02642-10

Mégraud F, Lehours P. Helicobacter pylori detection and antimicrobial susceptibility testing. Clin Microbiol Reviews 2007; 20: 280-332. http://dx.doi.org/10.1128/CMR.00033-06 DOI: https://doi.org/10.1128/CMR.00033-06

Rerksuppaphol S, Hardikar W, Midolo PD, Ward P. Antimicrobial resistance in Helicobacter pylori isolates in children. J Pediatr Child Health 2003; 39: 332-5. http://dx.doi.org/10.1046/j.1440-1754.2003.00153.x DOI: https://doi.org/10.1046/j.1440-1754.2003.00153.x

Downloads

Published

2014-07-25

How to Cite

Penagini, F., Dilillo, D., Torcoletti, M., Mauri, S., Fociani, P., & Zuccotti, G. V. (2014). Helicobacter Pylori and Iron Deficiency Anemia in Children: Case Series and Review of Literature . International Journal of Pediatrics and Child Health, 2(2), 39–44. https://doi.org/10.12974/2311-8687.2014.02.02.3

Issue

Section

Articles