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Clinical Topics

No Link Found Between H. Pylori Infection, Unexplained Anemia

by U.S. Medicine

May 21, 2018

SYRACUSE, NY — Despite limited evidence to support the practice, testing for Helicobacter pylori (Hp) infection is recommended for work-up of unexplained iron deficiency anemia (IDA).

A study published in the journal Gastroenterology Report sought to investigate the association between Hp infection and unexplained iron deficiency (ID) or IDA in the older adult population without significant upper gastrointestinal source of blood loss.1

“Peptic ulcer disease caused by Hp infection can lead to gastrointestinal blood loss and IDA,” wrote State University of New York (SUNY), Upstate Medical University-led researchers. “Whether Hp infection can lead to IDA in the absence of peptic ulcer disease is controversial. Most of the data supporting association of Hp infection and IDA come from clinical studies conducted in children and premenopausal women with a relatively high iron requirement and in those living in areas with a high prevalence for Hp infection.

“The majority of the epidemiological studies that support this association have used serologic tests that do not necessarily diagnose active Hp infection,” they added. “In addition, most of these studies have not ruled out the major causes of IDA, such as peptic ulcer disease by esophagogastroduodenoscopy (EGD). Thus, the applicability of the available study findings in adult population living in areas with low prevalence for Hp infection who are not vulnerable to ID is controversial. The available data supporting association between Hp infection and ID do not prove cause and effect.”

To clarify the connection, the study team conducted research involving collection of Hp infection data on 1,253 consecutive patients undergoing diagnostic or therapeutic upper gastrointestinal endoscopy at the Syracuse, NY, VAMC from Jan. 1, 1998, to April 28, 2004. They compared the Hp-positive and Hp-negative groups to identify significant risk factors associated with ID and IDA.

Researchers noted that 523 of them had no significant upper and/or lower gastrointestinal source for blood loss or risk factors for IDA.

Overall, 103 of the patients (19.7%) had Hp infection, and 420 (80.3%) were found to be negative for Hp. In addition, 68 (22.1%) out of 307 subjects with available serum iron profile had unexplained ID, and 28 (5.4%) out of 510 subjects with available hemoglobin profile had unexplained IDA. No association was found between ID/IDA and Hp infection in univariate and multiple logistic regression analyses, the researchers pointed out.

“We found no association between unexplained ID or IDA and Hp infection in older adult population without peptic ulcer disease or significant upper gastrointestinal source of blood loss,” the study authors concluded.


1Savio John, Juan Diego Baltodano, Nilesh Mehta, Katherine Mark, Uma Murthy; Unexplained iron deficiency anemia: does Helicobacter pylori have a role to play?, Gastroenterology Report, published 08 February 2018. https://doi.org/10.1093/gastro/goy001

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