Iron deficiency in Helicobacter pylori infected patients in Baghdad

Journal of Microbiology and Jasem 114 Infectious MA, Diseases et al. Iron/ deficiency in Helicobacter pylori infection 2011; 1 (3): 114-117 JMID doi: 10.5799/ahinjs.02.2011.03.0026 ORIGINAL ARTICLE Iron deficiency in Helicobacter pylori infected patients in Baghdad Meroj A. Jasem1, Alia A. Al-Ubaidi1, Najah M. Daood2, Jenan A. Muhsin1 Biology Dep., College of Science, Al-Mustansyria University, Baghdad, Iraq 1 Medical City, Educational Laboratories, Baghdad, Iraq 2 ABSTRACT Objectives: Recent studies have suggested an association of Helicobacter pylori and iron deficiency (ID). Materials and methods: To examine an association between H.pylori infection and ID, blood sampling and a data collection survey were performed in 78 H.pylori infected patients and 22 healthy subjects as control. Serum ferritin and iron were measured by ELISA and direct enzymatic method techniques respectively. Results: The result showed that 24 of the patients (30.7%) have serum ferritin and iron concentrations below the normal range indicating iron deficiency, with no significantly difference between women and men. ID was more pronounced in patients with stomach ulcer (58.3%) than those without stomach ulcer (41.7%) respectively. Conclusions: The conclusion was that H.pylori infection might have a role in iron deficiency and subsequently iron deficiency anemia. J Microbiol Infect Dis 2011; 1(3):114-117 Key words: Iron deficiency, anemia, H.pylori infection, ferritin Bağdat’ta Helicobacter pylori ile enfekte hastalarda demir eksikliği ÖZET Amaç: Son zamanlarda yapılan çalışmalar Helicobacter pylori ile demir eksikliği arasında bir ilişki ileri sürdüler. Materyal ve metot: H.pylori enfeksiyonu ile demir eksikliği arasındaki birlikteliği araştırmak için 78 H.pylori hastasından ve kontrol olarak 22 sağlıklı kişiden kan örnekleri ve anket çalışması yapıldı. Serum ferritin ve demir, sırasıyla, ELISA ve direk enzimatik metot tekniğiyle çalışıldı. Bulgular: Sonuçlar 24 hastada (% 30,7) serum ferritin ve demir konsantrasyonlarının normal değerlerden düşük olduğunu ve erkek ve kadın cinsleri arasında farklılık olmadığını gösterdi. Demir eksikliği mide ülseri olan hastalarda (% 58,3) olmayanlara (% 41,7) göre daha belirgindi. Sonuç: Sonuç olarak H. pylory enfeksiyonları demir eksikliğinde rol oynayabilir ve bu demir eksikliğiyle sonuçlanabilir. Anahtar kelimeler: Demir eksikliği, anemi, H.pylori enfeksiyonu, ferritin INTRODUCTION Helicobacter pylori are gram-negative urease producing organisms that are found throughout the world. Infection with H.pylori produces chronic gastritis. It may also predispose patients to develop duodenal ulcers, gastric lymphoma or carcinoma.1,2 Many studies postulated that H.pylori may disturb normal biochemistry like increase in plasma fibrinogen a modification of the serum lipid profile.3,4 Recent evidence suggests that H.pylori is associated with iron deficiency and anemia. Several cross-sectional studies have found an association between H.pylori and low body iron stores and iron deficiency anemia and a reduced response to iron supplementation.5-11 Weyermann et al found that pregnant women infected with H.pylori had lower mean hemoglobin (Hb) level at the beginning of pregnancy and a greater decrease in the mean Hb level at the end of pregnancy.12 In Kenya, anemic children had a 2.5-fold higher proportion of elevated IgM antibody titers against H.pylori than non-anemic children.13 Iron deficiency, defined as decreased total body iron content, is among the most common Correspondence: Dr. Meroj A Jasem Al-Mustansyria University, College of Science, Biology Department, Baghdad, Iraq Email: Received: 06.12.2011, Accepted: 28.12.2011 and Infectious Diseases 2011, All rights reserved J Microbiol Infect DisCopyright © Journal of Microbiology www.jcmid.org Vol 1, No 3, December 2011 Jasem MA, et al. Iron deficiency in Helicobacter pylori infection nutritional deficiencies in the world. Iron deficiency results in impairments in immune, cognitive, and reproductive functions, as well as decreased work performance. Iron deficiency develops through three stages: 1) iron depletion, 2) irondeficient erythropoiesis, and 3) iron-deficiency anemia (IDA).1 Although the mechanisms remain unclear, clinical and epidemiologic studies suggest that infection with H.pylori is associated with iron deficiency and IDA.14 Barabino hypothesized that gastritis increased levels of neutrophil-derived lactoferrin, and since H.pylori has a lactoferrin-binding protein receptor, the infection would result in increased iron losses related to bacterial turnover.15 A study of children in Alaska showed that anemia responded to oral iron replacement but recurred when iron therapy was discontinued, suggesting that mild chronic bleeding was involved.16 It seems likely that the pathogenesis is multifactorial, including combinations of reduced iron absorption related to decreased acid secretion, increased iron loss from microbleeding, and utilization by bacteria. The purpose of this study is to investigate the role of Helicobacter pylori gastritis in iron-deficiency (ID) in some Iraqi patients. MATERIALS AND METHODS The patients were referred to Digestive System Center where H.pylori infection was diagnosed endoscopically and the other part of the patients were referred to Immunology Department in Central Public Health Laboratories where H.pylori was diagnosed serologically by using anti-H. pylori IgG antibodies Elisa kit. Totally, 22 anti-H. pylori-IgG seronegative subjects were used as a control group. Epidemiological data such as age, sex, smoking habits, and drug treatment were recorded for all of the patients. Sample Collections Five milliliters (ml) venous blood was obtained from the subjects. All blood samples were dispensed into dry glass test tubes for clotting and retraction to take place. Sera were obtained after samples were centrifuged at 2000 g for five minutes and stored at -20°C until assayed for laboratory investigations. Laboratory Investigations: Ferritin is a very good marker for iron deficiency but since ferritin is an acute phase protein, it can be elevated in J Microbiol Infect Dis 115 inflammation conditions that a normal serum ferritin may not always exclude iron deficiency, so iron is measured too as another indicator for iron deficiency. Ferritin was detected by ELISA; this assay system utilizes one rabbit anti-ferritin antibody for solid phase immobilization and a mouse monoclonal anti-ferritin antibody in the antibodyenzyme (horseradish peroxidase) conjugate solution. The normal range of ferritin as recommended by BioCheck is 20-250ng/ml for male and 10120ng/ml for female. Serum iron concentration were investigated by direct enzymatic method; after dissociation of iron- transferring bound in acid medium, ascorbic acid reduces Fe+3 iron into Fe+2 iron. The absorbance measured at 600 nm is directly proportional to the amount of iron in the specimen. The normal rang of iron as (...truncated)