Is it necessary to screen Helicobacter pylori infection in patients with celiac disease and iron deficiency?

To The Editor

Early studies have not revealed a link between Helicobacter pylori and iron deficiency (1). A recent study from your journal revealed a significant association between H. pylori infection and iron deficiency anemia in patients with celiac disease. But the conclusion of this study was that H. pylori infection and iron deficiency anemia is poorly reflected in practice to celiac disease patients (2). However, I would like to highlight some points for more clarification of the issue. Long-term clinical outcomes were favorable to H. pylori eradication and provided evidence for a cause-effect relation between H. pylori and iron deficiency anemia (3). Mild enteropathy was common in patients with iron deficiency anemia and negative celiac disease serology. Final diagnoses in most patients with enteropathy were: gluten sensitive enteropathy with anemia, H. pylori infection with anemia, or bouth (4).  H. pylori infection was considered a risk factor for anemia due to iron deficiency, mainly in children and adolescent groups with high iron requirements (5). In severe iron deficiency anemia, more than 50% of patients had an active H. pylori infection (6). Therefore, we recommend performing the screening for H. pylori infection in patients with celiac disease and iron deficiency.