J Clin Pathol 66:343-347 doi:10.1136/jclinpath-2012-201243
  • Original article

Helicobacter pylori-associated hypochlorhydria in children, and development of iron deficiency

  1. Jean E Crabtree3
  1. 1Division of Paediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
  2. 2Department of Pathology, Imperial College, London, UK
  3. 3Molecular Gastroenterology Section, Leeds Institute Molecular Medicine, Leeds, UK
  4. 4Department of Pathology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
  5. 5Institute of Molecular Medicine, Trinity College Dublin, Dublin, Ireland
  1. Correspondence to Professor Jean E Crabtree, Leeds Institute of Molecular Medicine, St James's University Hospital, Leeds LS9 7TF, UK;  j.crabtree{at}
  • Received 15 October 2012
  • Revised 13 November 2012
  • Accepted 15 November 2012
  • Published Online First 25 December 2012


Aims Acute Helicobacter pylori infection is associated with transient hypochlorhydria. In H pylori-associated atrophy, hypochlorhydria has a role in iron deficiency (ID) through changes in the physiology of iron-complex absorption. The aims were to evaluate the association between H pylori-associated hypochlorhydria and ID in children.

Methods Symptomatic children (n=123) were prospectively enrolled. Blood, gastric juice and gastric biopsies were taken, respectively, for haematological analyses, pH assessment and H pylori determination, and duodenal biopsies for exclusion of coeliac disease. Stool samples were collected for parasitology/microbiology. Thirteen children were excluded following parasitology and duodenal histopathology, and five due to impaired blood analysis.

Results Ten children were hypochlorhydric (pH>4) and 33 were H pylori positive. In H pylori-positive children with pH>4 (n=6) serum iron and transferrin saturation levels % were significantly lower (p<0.01) than H pylori-positive children with pH≤4. No differences in ferritin, or total iron binding capacity, were observed. In H pylori-negative children with pH>4, iron and transferrin saturation were not significantly different from children with pH≤4.

Conclusions Low serum iron and transferrin in childhood H pylori infection is associated with hypochlorhydria. In uninfected children, hypochlorhydria was not associated with altered serum iron parameters, indicating a combination of H pylori infection and/or inflammation, and hypochlorhydria has a role in the aetiology of ID. Although H pylori-associated hypochlorhydria is transient during acute gastritis, this alters iron homeostasis with clinical impact in developing countries with a high H pylori prevalence.