The Effect of Helicobacter pylori Infection on Iron Stores and Iron Deficiency in Urban Alaska Native Adults

Background Helicobacter pylori (H.pylori) infection has been correlated with low serum ferritin and iron deficiency. As a secondary analysis of a study of H.pylori reinfection, we investigated the association of H.pylori infection and the effect of its eradication on serum ferritin and iron deficiency. Methods Alaska Native adults undergoing esophagogastroduodenoscopy had sera collected and a 13C urea breath test (UBT) was performed. Those H.pylori positive were treated with an antibiotic regimen; those who tested negative 2months after treatment were evaluated at 4, 6, 12, and 24months by UBT and serum ferritin with an immunoradiometric assay. We excluded persons from further analysis if they were prescribed iron by their provider. Results We measured serum ferritin for 241 persons; 121/241 were H.pylori positive. The geometric mean ferritin (GMF) for persons with and without H.pylori infection was 37g/L and 50g/L, respectively (p=.04). At enrollment, 19/121 H.pylori-positive persons had iron deficiency compared with 8/120 H.pylori negative (p=.02). Among 66 persons tested at 24months, the GMF was higher at 24months (49.6g/L) versus enrollment (36.5g/L; p=.02). Six of 11 persons with iron deficiency at enrollment no longer had iron deficiency and had a higher GMF (p=.02) 24months after treatment. Conclusions H.pylori infection was correlated with lower serum ferritin and iron deficiency. After H.pylori eradication, serum ferritin increased and approximately half of persons resolved their iron deficiency. Testing for H.pylori infection and subsequent treatment of those positive could be considered in persons with unexplained iron deficiency.