Helicobacter pylori infection and anemia.

Dear Sir:

In their comprehensive and rigorous study on the etiology of anemia in Côte d'Ivoire, Righetti and others1 reported high prevalence of anemia (45–75%), inflammation, and deficiencies of iron, riboflavin, and vitamin A. The factors that were significantly and positively linked to the prevalence of anemia differed by age group: (1) infection with Plasmodium falciparum in 6- to 23-month-old children, (2) cellular iron deficiency and chronic inflammation in 6- to 8-year-old children, and (3) cellular iron deficiency in non-pregnant young women.1 Identifying modifiable risk factors like the factors reported by Righetti and others1 is highly important and can help in establishing interventions aimed at reducing the burden of anemia.

Helicobacter pylori colonizes the stomach; typically, it is acquired in childhood and causes asymptomatic chronic infection, which is highly endemic in developing countries.2 A small portion of H. pylori-infected subjects develop peptic ulcers and gastric carcinoma, usually in late adulthood.2 In well-designed studies, H. pylori was found to be associated with increased likelihood of iron deficiency anemia (IDA)3,4; furthermore, anti-H. pylori therapy substantially reduced the percentage of children affected with IDA.5 In a community-based study among Arab children in Israel, we found significantly lower mean hemoglobin levels in children ages 6–9 years who were infected with H. pylori compared with their uninfected peers.6 H. pylori was also associated with low ferritin levels.6,7 In a systematic review and meta-analysis,8 we found higher prevalence of IDA in H. pylori-infected subjects than uninfected ones (pooled odds ratio = 2.8; 95% confidence interval = 1.9–4.2).8

We recommend the investigation of H. pylori infection as a potential factor that might play a role in the occurrence of anemia in this population.1 Trials on the impact of anti-H. pylori therapy on the burden of anemia and IDA could shed light on whether the association between H. pylori and these disorders is causal.