http://annalsofrscb.ro 1554
Association of Chronic Helicobacter pylori infection with Iron Deficiency Anemia
Qusay Abdulazahraa Yaqoob1, Haider Ali Mahdi2, Hassan Ali Farman3, Mohammed Abdulzahra Sasaa4
1University of kufa/Iraq
2 Ministry of Health, Al-Sader Medical City, Al-Najaf, Iraq
3 Department of Anesthesia and intensive care techniques, college of Health & Medical Techniques, Al-Furat Al- Awsat technical university, Iraq.
4Al-Mustaqbal University College, Anesthesia techniques department, Hillah, Iraq.
*Corresponding Author’s E-mail: [email protected]
Abstract- The study sample consisted of 120 participants divided equally into two groups; 60 patients with H.pylori infectin with iron defeciency anemia and 60 healthy individuals. Their age ranged between 30–70 years, 27 of them were males and 33 were females. H. pylori patients were recruited the Al Sadder Teaching Hospital and the Gastrointestinal Diseases center in Al- Najaf AL-Ashraf city, through the duration of December 2019 till February 2020. All patients diagnosed with H.pylori by clinical symptoms and confirmed by H. pylori stool antigen was detected by strips. Verbal consent is taken from each patient before sample. Ten ml of blood are withdrawn by vein puncture from H.pylori patients and healthy control. A tourniquet was applied directly on the skin around the arm, the skin over the vein was sterilized with 70٪ ethyl alcohol, then blood was collected divided into three part; one (2ml) transfer to EDTA tube for estimation of CBC, part two (2ml) was put in ESR tube with anticoagulant and part three (4 ml) put gel tube to be allowed to clot at room temperature for 15-20 minutes, and then it was centrifuged for 5 minutes at 5000xg , to get the serum, the serum was collected for estimation of iron, ferritin, AST and ALT. The result shows that there were statistically significant differences at 0.05 in Hb level between cases (m= 10.91) and controls (m= 14.26), P value 0.000, which means that Hb level was significantly lower among cases compared to controls. In addition, there were statistically non-significant differences at 0.05 in RBC between cases (m= 4.36) and controls (m= 4.55), P value >0.05, which means that RBC were lower among cases compared to controls. In addition, there were statistically significant differences at 0.05 in WBCs between cases (m= 9.76) and controls (m=8.68), P value <0.05, which means that WBCs were significantly higher among cases compared to controls. The results also shows that there were statistically significant differences at 0.05 in PCV level between cases (m= 32.33) and controls (m= 43.01), P value 0.000, which means that PCV level was significantly lower among cases compared to controls.
Furthermore, there were statistically significant differences at 0.05 in MCV level between cases (m= 63.18) and controls (m=83.56), P value 0.000, which means that MCV level was significantly lower among cases compared to controls. On the other hand, there were statistically insignificant differences between the two groups in levels of MCHC (P=>0.05). In addition, there were statistically significant differences at 0.05 in MCH and PLT between cases and controls P value 0.000. The result also shows that there were statistically significant differences at 0.05 in serum iron, ferritin, AST and ALT level between cases and controls, P value 0.001. In addition, there were statistically significant differences at 0.05 in ESR level between cases and controls P value 0.000.
http://annalsofrscb.ro 1555 Index Terms- H.pylori, iron deficiency anemia.
INTRODUCTION
Helicobacter pylori is a type of helicobacter known as a "gastric" helicobacter. It persists in the intestine, either inside or under the mucous layer anterior to the epithelium in the stomach. In a temporary basis, it also can be found in the duodenum, saliva, and feces. H. pylori infection that can cause acute gastritis symptoms. The majority of infected people develop chronic active gastritis, which may cause non-ulcer dyspepsia or duodenal ulcers. 90% of duodenal ulcers and nearly all gastric ulcers have been related to Helicobacter pylori (Muhammad & Ali, 2018). Iron deficiency, whether or not it is associated with anemia, is a severe medical issue. It usually takes place as part of a long-term, slow-onset disease during which the iron deficiency evolves and appears clinically over many years (Al-Zaiyadi et al., 2019: Greer et al., 2018). The mechanism by which Helicobacter pylori causes iron deficiency anemia is unknown. In H. pylori-infected patients, serum hepcidin levels are raised up, but these levels return to normal after the infection is eradicated, allowing the iron to be absorbed. Absorbed by the enterocytes and released from macrophages of the reticuloendothelial system, where they are restricted (Ge & Sun, 2012).
Another cause of iron deficiency in H. pylori patients is chronic blood loss caused by chronic gastritis, which can be serious enough to causes chronic gastritis, particularly in patients with active bleeding peptic ulcers and those who take NSAIDs such as aspirin on a regular basis (Rahman et al., 2019). Rostami-Nejad et al., (2015), shown that even in celiac disease patients, H. pylori linked to iron deficiency anemia, which was clearly evidence based but poorly represented in practice. An association among anemia and H. pylori infection is supported by a variety of epidemiological and clinical studies. However, studies from various areas and countries disagree about the connection between anemia and cancer (Al-Badry et al., 2020;
Hudaketal.,2017).
Materials and Methods
Patients :
The study sample consisted of 120 participants divided equally into two groups; 60 patients with H.pylori infectin with iron defeciency anemia and 60 healthy individuals. Their age ranged between 30–70 years, 27 of them were males and 33 were females. H. pylori patients were recruited the Al Sadder Teaching Hospital and the Gastrointestinal Diseases center in Al-Najaf AL-Ashraf city, through the duration of December 2019 till February 2020. All patients diagnosed with H.pylori by clinical symptoms and confirmed by H. pylori stool antigen was detected by strips. Verbal consent is taken from each patient before sample.
Control :
Forty-five apparently healthy were selected as the control, the patient and controls (N: 60) were age and sex matched. All control group was had no family history of disease.
http://annalsofrscb.ro 1556 Exclusion criteria:
- Patients who underwent H. pylori eradication therapy or steroids.
- Patients who are receiving immunosuppressive or chemotherapeutic drugs.
- Pregnant female patients.
- Patients who have had a stomach resection or a small bowl operation in the past.
- Vegetarian population
-Malabsorption syndrome and folic acid deficiency patients.
Sample collection:
Ten ml of blood are withdrawn by vein puncture from H.pylori patients and healthy control.
A tourniquet was applied directly on the skin around the arm, the skin over the vein was sterilized with 70٪ ethyl alcohol, then blood was collected divided into three part; one (2ml) transfer to EDTA tube for estimation of CBC, part two (2ml) was put in ESR tube with anticoagulant and part three (4 ml) put gel tube to be allowed to clot at room temperature for 10-15 minutes, and then it was centrifuged for 5 minutes at 5000xg , to get the serum, the serum was collected for estimation of iron, ferritin, AST and ALT.
Statistical Analysis :
Data of the study participants, H.pylori patients and controls, were entered, managed and evaluated by the Statistical Package For Social Sciences (SPSS) version 25 software for windows, IBM, US, 2017. The results were expressed as (Mean ± SD), two independent t-test has been used for the comparison between the patients and control groups in the measured parameters. A statistical significance (P. value) of 0.05 or less is regarded as significant.
Results:
Table 1 indicates that there were statistically significant variations in Hb level between cases (m= 10.91) and controls (m= 14.26), P value 0.000, indicating that cases had significantly lower Hb levels in compsrison with controls. Also, there were statistically non significant variances at 0.05 in RBC between cases (m= 4.36) and controls (m= 4.55), P value >0.05, which means that RBC were lower among cases compared to controls. In addition, statistically relevant variations existed at 0.05 in WBCs between cases (m= 9.76) and controls (m=8.68), P value <0.05, which means that WBCs were significantly higher among cases compared to controls. The results also shows that there were statistically significant differences at 0.05 in PCV level between cases (m=
32.33) and controls (m= 43.01), P value 0.000, which means that PCV level was significantly lower among cases compared to controls. Furthermore, there were statistically significant differences at 0.05 in MCV level between cases (m= 63.18) and controls (m=83.56), P value 0.000, which means that MCV level was significantly lower among cases comparison to controls.
On the other hand, there were no statistically significant differences in MCHC levels between the two groups (P>0.05). Additionally, there were statistically significant differences at 0.05 in MCH and PLT between cases and controls P value 0.000.
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Table (2) shows that there were statistically significant variations between cases and controls in serum iron, ferritin, AST, and ALT levels at 0.05, with a P value of 0.001. Consequently, there were statistically significant variations in ESR levels between cases and controls at the 0.05 level, with a P value of 0.000.
Table (1): Comparison of mean values of Hb, PCV ,RBC count, WBC count, MCV, MCH, MCHC and PLT of H.pylori patients and controls
P. value Group
parameter Control
(n=60) Patients
(n=60)
SD*
Mean SD*
Mean
< 0.001 1.39
14.26 2.31
10.91 Hb mg/dl
< 0.001 4.92
43.01 5.38
32.33 PCV%
> 0.05 0.7
4.55 0.89
4.36 RBCs x10
12/L
< 0.05 4.08
8.68 2.72
9.76 WBCs x10
9/L
< 0.001 7.37
83.56 6.49
63.18 MCV (fl)
< 0.001 3.49
27.72 4.98
22.31 MCH (pg)
> 0.05 1.92
33.16 1.84
33.08 MCHC (g/dl)
< 0.001 100.2
279.98 94.25
292.86
PLT x10
9/L
http://annalsofrscb.ro 1558 .
Table (2): Comparison of mean values of iron, ferritin, AST, ALT and ESR of H.pylori patients and controls.
Discussion:
Iron deficiency is related to many of the health problems and is the major cause of anemia around the world. Iron deficiency may occur due to dietary deficiency or chronic blood loss (Means, 2013).Also, H. Pylori is the most common chronic microbial infection worldwide, and is considered as a main cause for occurrence of gastriculcers, duodenal ulcers, atrophic gastritis, and gastric carcinoma (Asaka et al., 2010). Many studies showed different explanation for the mechanism of relationship among Helicobacter pylori and iron deficiency and iron deficiency anemia. Baysoy et al. revealed that patients with H. Pylori has lower gastric ascorbic acid and decreased serum iron levels, and also have physiological and histological gastric changes (Nori et al., 2021; Hussein et al., 2021: Baysoy et al., 2004). Also, a high serum gastrin level and intragastric PH was observed in H. pylori infected subjects with iron deficiency anemia, which may lead to atrophic gastritis and aclorhydria (Saleh & Hassan, 2015). Huang et al., showed that patients with iron deficiency anemia show an improvement after eradication of H. pylori (Huang et al., 2010). Nakagawa et al., who also found a significance lower serum ferritin level in H.
pylori positive patients (Nakagawa et al., 2013). Moreover, patients with chronic gastritis related to H.pylori infection had increased serum level of hepcidin resulting in decreased iron absorption and iron deficiency anemia (Azab & Esh, 2013). These variable results were explained by, chronic gastritis, gastric or duodenal ulcerations related to H. pylori infection and the consequent chronic blood loss has an important role in iron deficiency occurrence in these patients (Monzón etal.,2013).
P. value Group
parameter Control
(n=60) Patients
(n=60)
SD*
Mean SD*
Mean
< 0.001 9.49
82.63 6.04
22.31 Iron µg/dl
< 0.001 12.3
70.28 5.01
15.72 Ferritin ng/ml
< 0.001 7.42
20.98 10.64
32.33 AST U/L
< 0.001 7.42
17.81 4.48
43.02 ALT U/L
< 0.001 6.68
14.91 24.8
52.61
ESR mm/1h
http://annalsofrscb.ro 1559 Conclusion:
This research suggests that H. pylori infection is linked to anemia, haemoglobin, and ferritin levels.
REFERENCES
[1] Muhammad, A. Q., & Ali, C. I. A. D. (2018). Evaluation the relationship between the antibodies of Helicobacter pylori and Interleukin-6 in patients with gastritis in Kirkuk province. Tikrit Journal of Pure Science, 23(6), 12-17.
[2] Al-Zaiyadi, S. M. W., Salih, A. M., Sabr, I. A., Al-Murshidi, S. Y., Roomi, A.
B., Dheyaa, A. M., & Al Koofee, M. K. (2019). Impact of fertilization rate on icsi outcome and pregnancy rate for unexplained subfertile couples. Indian Journal of Public Health Research and Development, 10(11), 2202-2206.
doi:10.5958/09765506.2019.03887.7.
[3] Greer, J. P., Arber, D. A., Glader, B. E., List, A. F., Means, R. M., & Rodgers, G. M.
(2018). Wintrobe's clinical hematology. Lippincott Williams & Wilkins.
[4] Ge, R., & Sun, X. (2012). Iron trafficking system in Helicobacter pylori. Biometals, 25(2), 247-258.
[5] Rahman, Y. A., wahid Ahmed, L. A., Hafez, R. M. M., & Ahmed, R. M. M. (2019).
Helicobacter pylori and its hematological effect. The Egyptian Journal of Internal Medicine, 31(3), 332-342.
[6] Rostami-Nejad, M., Aldulaimi, D., Livett, H., & Rostami, K. (2015). H. pylori associated with iron deficiency anemia even in celiac disease patients; strongly evidence based but weakly reflected in practice. Gastroenterology and hepatology from bed to bench, 8(3), 178.
[7] Al-Badry, S. H., Khalaf, S. A., Al-Khuzaiy, A. A., & Roomi, A. B. (2020). The effects of irisin on the transforming growth factorbeta1(TGF-β1) level in type-1 diabetic patients in thiqar province. International Journal of Pharmaceutical Research, 12(4), 2523-2529. doi:10.31838/ijpr/2020.12.04.349.
[8] Hudak, L., Jaraisy, A., Haj, S., & Muhsen, K. (2017). An updated systematic review and meta‐analysis on the association between H elicobacter pylori infection and iron deficiency anemia. Helicobacter, 22(1), e12330.
[9] Means, R. T. (2013). Iron deficiency anemia. Hematology (Amsterdam, Netherlands), 18(5), 305.
[10] Asaka, M., Kato, M., Takahashi, S. I., Fukuda, Y., Sugiyama, T., Ota, H., ... & Sugano, K. (2010). Guidelines for the management of Helicobacter pylori infection in Japan: 2009 revised edition. Helicobacter, 15(1), 1-20.
http://annalsofrscb.ro 1560
[11] Hussein, K. A., Salih, H. A., & Roomi, A. B. (2021). The effect of chemical compounds on smartphone surface-isolated bacteria. Annals of the Romanian Society for Cell Biology, 25(2), 2190-2197.
[12] Nori, W., Abdulghani, M., Roomi, A. B., & Akram, W. (2021). To operate or to wait? doppler indices as predictors for medical termination for first trimester missed abortion. Clinical and Experimental Obstetrics and Gynecology, 48(1), 169-175. doi:10.31083/j.ceog.2021.01.2215.
[13] Baysoy, G., Ertem, D., Ademoglu, E., Kotiloglu, E., Keskin, S., & Pehlivanoglu, E.
(2004). Gastric histopathology, iron status and iron deficiency anemia in children with Helicobacter pylori infection. Journal of pediatric gastroenterology and nutrition, 38(2), 146-151.
[14] Saleh, M. A., & Hassan, E. A. (2015). THE RELATIONSHIP BETWEEN HELICOBACTER PYLORI AND IRON DEFICIENCY ANEMIA. AL-AZHAR ASSIUT MEDICAL JOURNAL, 13(3).
[15] Huang, X., Qu, X., Yan, W., Huang, Y., Cai, M., Hu, B., ... & Lu, L. (2010). Iron deficiency anaemia can be improved after eradication of Helicobacter pylori. Postgraduate medical journal, 86(1015), 272-278.
[16]
[17] Nakagawa, H., Tamura, T., Mitsuda, Y., Kurata, M., Goto, Y., Kamiya, Y., ... &
Hamajima, N. (2013). Association Between Helicobacter pylori Infection Detected by the 13C‐Urea Breath Test and Low Serum Ferritin Levels among Japanese Adults. Helicobacter, 18(4), 309-315.
[18] Azab, S. F., & Esh, A. M. (2013). Serum hepcidin levels in Helicobacter pylori-infected children with iron-deficiency anemia: a case–control study. Annals of hematology, 92(11), 1477-1483.
[19] Monzón, H., Forné, M., Esteve, M., Rosinach, M., Loras, C., Espinós, J. C., ... &
Fernández-Bañares, F. (2013). Helicobacter pylori infection as a cause of iron deficiency anaemia of unknown origin. World journal of gastroenterology: WJG, 19(26), 4166.
