European Journal of Pediatrics

, Volume 162, Issue 3, pp 177–179 | Cite as

Refractory iron-deficiency anaemia due to silent Helicobacter pylori gastritis in children

  • Maria Kostaki
  • Smaragdi FessatouEmail author
  • Themistocles Karpathios
Original Paper


We describe the cases of three children with chronic active Helicobacter pylori gastritis and iron-deficiency anaemia without evidence of oesophagogastrointestinal bleeding. In all cases, long-standing iron supplementation became effective only after eradication of Helicobacter pylori. Conclusion: Iron-deficiency anaemia may be due to clinically inapparent H. pylori gastritis.


Helicobacter pylori gastritis Iron-deficiency anaemia 



Iron-deficiency anaemia


Helicobacter pylori


  1. 1.
    Barabino A (2002) Helicobacter pylori-related iron deficiency anemia: a review. Helicobacter 7:71–75CrossRefPubMedGoogle Scholar
  2. 2.
    Barabino A, Dufour C, Marino CM, Claudiani F, Alessandri A (1999) Unexplained refractory iron-deficiency anemia associated with Helicobacter pylori gastric infection in children: further clinical evidence. J Pediatr Gastroenterol Nutr 28:116–119CrossRefPubMedGoogle Scholar
  3. 3.
    Bardhan PK, Hildebrand P, Sarker SA, Fuchs G, Mahalanabis D, Beglinger C, Gyr K (1997) Helicobacter pylori infection in children: is there an association with anemia? Gastroenterology 112:A1123Google Scholar
  4. 4.
    Blecker U, Renders F, Lanciers S, Vandenplas Y (1991) Syncopes leading to the diagnosis of Helicobacter pylori positive chronic active haemorrhagic gastritis. Eur J Pediatr 150:560–561CrossRefPubMedGoogle Scholar
  5. 5.
    Bruel H, Dabadie A, Pouedras P, Gambert C, Gall LE, Jezequel C (1993) Acute anemia as the first manifestation of Helicobacter pylori gastritis. Ann Pediatr Paris 40:364–367PubMedGoogle Scholar
  6. 6.
    Canadian Helicobacter Study Group (1999) Consensus conference on the approach to Helicobacter pylori infections in children and adolescents. Can J Gastroenterol 13:553–559CrossRefGoogle Scholar
  7. 7.
    Choe YH, Kim SK, Son BK, Lee DH, Hong YC, Pai SH (1999) Randomized placebo-controlled trial of Helicobacter pylori eradication for iron-deficiency anemia in preadolescent children and adolescents. Helicobacter 4:135–139CrossRefPubMedGoogle Scholar
  8. 8.
    Choe YH, Kim SK, Hong YC (2000) Helicobacter pylori infection with iron deficiency anaemia and subnormal growth at puberty. Arch Dis Child 82:136–140CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Dhaenens L, Szczebara F, Husson MO (1997) Identification, characterization, and immunogenicity of the lactoferin-binding protein from Helicobacter pylori. Infect Immun 65:514–518PubMedPubMedCentralGoogle Scholar
  10. 10.
    Drumm B, Koletzko S, Oderda G on behalf of the European Paediatric Task Force on Helicobacter pylori (2000) Helicobacter pylori in children. Report of a consensus conference held in Budapest, September 1998. J Pediatr Gastroenterol Nutr 30:207–213CrossRefPubMedGoogle Scholar
  11. 11.
    Dufour C, Brisigotti M, Fabretti G, Luxardo P, Mori PG, Barabino A (1993) Helicobacter pylori gastric infection and sideropenic refractory anemia. J Pediatr Gastroenterol Nutr 17:225–227CrossRefPubMedGoogle Scholar
  12. 12.
    Gold BD, Colletti RB, Abott M, Czinn SJ, Elitsur Y, Hassal E, Macarthur C, Snyder J, Sherman PM (2000) Helicobacter pylori infection in children. Recommendations for diagnosis and treatment. J Pediatr Gastroenterol Nutr 31:490–497CrossRefPubMedGoogle Scholar
  13. 13.
    Gutierrez O, Melo M, Segura AM, Angel A, Genta RM, Graham DY (1997) Cure of Helicobacter pylori infection improves gastric acid secretion in patients with corpus gastritis. Scand J Gastroenterol 32:664–668CrossRefPubMedGoogle Scholar
  14. 14.
    Hallissey MT, Allum WH, Jewkes AJ, Ellis DJ, Fielding JWL (1990) Early detection of gastric cancer. BMJ 301:513–515CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Husson MO, Legrand D, Spik G, Henri L (1993) Iron acquisition by Helicobacter pylori: importance of human lactoferrin. Infect Immun 61:2694–2697PubMedPubMedCentralGoogle Scholar
  16. 16.
    Kabuto M, Imai H, Tsugane S, Watanabe S (1993) Does high gastric cancer risk associated with low serum ferritin level reflect achlorhydria? An examination via cross-sectional study. Jpn J Cancer Res 84:844–851CrossRefPubMedGoogle Scholar
  17. 17.
    Knigge KL (2001) The role of H pylori in gastrointestinal disease: a guide to identification and eradication. Postgrad Med 110:71–82CrossRefPubMedGoogle Scholar
  18. 18.
    Konno M, Muraoka S, Takahashi M, Imai T (2000) Iron-deficiency anemia associated with Helicobacter pylori gastritis. J Pediatr Gastroenterol Nutr 31:52–56CrossRefPubMedGoogle Scholar
  19. 19.
    Kuipers EJ, Uyterlinde AM, Peña AS, Roosendaal R Pals G, Nelis GF, Festen HPM, Meuwissen SGM (1995) Long-term sequelae of Helicobacter pylori gastritis. Lancet 345:1523–1528CrossRefGoogle Scholar
  20. 20.
    Luqmani YA, Campbell TA, Bennet C, Coombes RC, Peterson IM (1991) Expression of lactoferrin in stomach. Int J Cancer 49:684–687CrossRefPubMedGoogle Scholar
  21. 21.
    Marignani M, Angeletti S, Bordi C, Malagnino C, Delle Fave G, Annibale B (1997) Reversal of long-standing iron deficiency anaemia after eradication of Helicobacter pylori infection. Scand J Gastroenterol 32:617–622CrossRefPubMedGoogle Scholar
  22. 22.
    Milman N, Rosenstock S, Andersen L, Jørgensen T, Bonnevie O (1998) Serum ferritin, hemoglobin, and Helicobacter pylori infection: a seroepidemiologic survey comprising 2794 Danish adults. Gastroenterol 115:268–274CrossRefGoogle Scholar
  23. 23.
    Otto BR, Verweij-van Vught Am, McLaren DM (1992) Transferrins and heme-compounds as iron sources for pathogenic bacteria. Crit Rev Microbiol 18:217–233CrossRefPubMedGoogle Scholar
  24. 24.
    Wainwright RB (1996) The US Arctic Investigations Program: infectious disease prevention and control research in Alaska. Lancet 347:517–520CrossRefPubMedGoogle Scholar
  25. 25.
    Wosrt DJ, Otto BR, deGraaff J (1995) Iron-repressible outer membrane proteins of Helicobacter pylori involved in heme uptake. Infect Immun 63:4161–4165Google Scholar
  26. 26.
    Yip R, Limburg PJ, Ahlquist DA, Carpenter HA, O'Neil A, Kruse D, Stitham S, Gold BD, Gunter EW, Looker AC, Parkinson AJ, Nobmann ED, Petersen KM, Ellefson M, Schwartz S (1997) Pervasive occult gastrointestinal bleeding in an Alaska native population with prevalent iron deficiency: role of Helicobacter pylori gastritis. JAMA 227:1135–1139CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  • Maria Kostaki
    • 1
  • Smaragdi Fessatou
    • 2
    • 3
    Email author
  • Themistocles Karpathios
    • 1
  1. 1.2nd Department of PaediatricsUniversity of AthensGreece
  2. 2.2nd Department of Paediatrics"P & A Kyriakou" Children's HospitalAthensGreece
  3. 3.N. Philadelphia, AthensGreece

Personalised recommendations