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

J Clin Pathol. 2013 Apr;66(4):343-7. doi: 10.1136/jclinpath-2012-201243. Epub 2012 Dec 25.

Abstract

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Achlorhydria / blood*
  • Achlorhydria / diagnosis
  • Achlorhydria / microbiology*
  • Adolescent
  • Age Factors
  • Biopsy
  • Chi-Square Distribution
  • Child
  • Endoscopy, Gastrointestinal
  • Feces / microbiology
  • Female
  • Gastric Acidity Determination
  • Gastric Juice / metabolism
  • Gastric Juice / microbiology
  • Gastric Mucosa / metabolism*
  • Helicobacter Infections / complications
  • Helicobacter Infections / diagnosis
  • Helicobacter Infections / microbiology*
  • Helicobacter pylori / isolation & purification*
  • Humans
  • Hydrogen-Ion Concentration
  • Iron / blood
  • Iron Deficiencies*
  • Male
  • Predictive Value of Tests
  • Prospective Studies
  • Stomach / microbiology*
  • Transferrin / analysis

Substances

  • Transferrin
  • Iron