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Role of autoimmune gastritis, Helicobacter pylori and celiac disease in refractory or unexplained iron deficiency anemia.
Haematologica. 2005 May; 90(5):585-95.H

Abstract

BACKGROUND AND OBJECTIVES

Conventional endoscopic and radiographic methods fail to identify a probable source of gastrointestinal blood loss in about one third of males and post-menopausal females and in most women of reproductive age with iron deficiency anemia (IDA). Such patients, as well as subjects refractory to oral iron treatment, are often referred for hematologic evaluation.

DESIGN AND METHODS

Patient clinic, screened for non-bleeding gastrointestinal conditions including celiac disease (antiendomysial antibodies), autoimmune atrophic gastritis (hypergastrinemia with strongly positive antiparietal cell antibodies) and H. pylori infection (IgG antibodies confirmed by urease breath test).

RESULTS

The mean age of all subjects was 39+/-18 years, and 119 of 150 were females. We identified 8 new cases of adult celiac disease (5%). Forty IDA patients (27%) had autoimmune atrophic gastritis of whom 22 had low serum vitamin B12 levels. H. pylori infection was the only finding in 29 patients (19%), but was a common co-existing finding in 77 (51%) of the entire group. Refractoriness to oral iron treatment was found in 100% of patients with celiac disease, 71% with autoimmune atrophic gastritis, 68% with H. pylori infection, but only 11% of subjects with no detected underlying abnormality. H. pylori eradication in previously refractory IDA patients in combination with continued oral iron therapy resulted in a significant increase in hemoglobin from 9.4+/-1.5 (mean +/- 1SD) before, to 13.5+/-1.2 g/ dL (p<0.001 by paired t test) within 3 to 6 months.

INTERPRETATION AND CONCLUSIONS

The recognition that autoimmune atrophic gastritis and H. pylori infection may have a significant role in the development of unexplained or refractory IDA in a high proportion of patients should have a strong impact on our daily practice of diagnosing and managing IDA.

Authors+Show Affiliations

Department of Hematology, Shaare Zedek Med Center, Jerusalem, Israel. hershko@szmc.org.ilNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15921373

Citation

Hershko, Chaim, et al. "Role of Autoimmune Gastritis, Helicobacter Pylori and Celiac Disease in Refractory or Unexplained Iron Deficiency Anemia." Haematologica, vol. 90, no. 5, 2005, pp. 585-95.
Hershko C, Hoffbrand AV, Keret D, et al. Role of autoimmune gastritis, Helicobacter pylori and celiac disease in refractory or unexplained iron deficiency anemia. Haematologica. 2005;90(5):585-95.
Hershko, C., Hoffbrand, A. V., Keret, D., Souroujon, M., Maschler, I., Monselise, Y., & Lahad, A. (2005). Role of autoimmune gastritis, Helicobacter pylori and celiac disease in refractory or unexplained iron deficiency anemia. Haematologica, 90(5), 585-95.
Hershko C, et al. Role of Autoimmune Gastritis, Helicobacter Pylori and Celiac Disease in Refractory or Unexplained Iron Deficiency Anemia. Haematologica. 2005;90(5):585-95. PubMed PMID: 15921373.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Role of autoimmune gastritis, Helicobacter pylori and celiac disease in refractory or unexplained iron deficiency anemia. AU - Hershko,Chaim, AU - Hoffbrand,A Victor, AU - Keret,Dan, AU - Souroujon,Moshe, AU - Maschler,Itzhak, AU - Monselise,Yehudit, AU - Lahad,Amnon, PY - 2005/6/1/pubmed PY - 2007/11/13/medline PY - 2005/6/1/entrez SP - 585 EP - 95 JF - Haematologica JO - Haematologica VL - 90 IS - 5 N2 - BACKGROUND AND OBJECTIVES: Conventional endoscopic and radiographic methods fail to identify a probable source of gastrointestinal blood loss in about one third of males and post-menopausal females and in most women of reproductive age with iron deficiency anemia (IDA). Such patients, as well as subjects refractory to oral iron treatment, are often referred for hematologic evaluation. DESIGN AND METHODS: Patient clinic, screened for non-bleeding gastrointestinal conditions including celiac disease (antiendomysial antibodies), autoimmune atrophic gastritis (hypergastrinemia with strongly positive antiparietal cell antibodies) and H. pylori infection (IgG antibodies confirmed by urease breath test). RESULTS: The mean age of all subjects was 39+/-18 years, and 119 of 150 were females. We identified 8 new cases of adult celiac disease (5%). Forty IDA patients (27%) had autoimmune atrophic gastritis of whom 22 had low serum vitamin B12 levels. H. pylori infection was the only finding in 29 patients (19%), but was a common co-existing finding in 77 (51%) of the entire group. Refractoriness to oral iron treatment was found in 100% of patients with celiac disease, 71% with autoimmune atrophic gastritis, 68% with H. pylori infection, but only 11% of subjects with no detected underlying abnormality. H. pylori eradication in previously refractory IDA patients in combination with continued oral iron therapy resulted in a significant increase in hemoglobin from 9.4+/-1.5 (mean +/- 1SD) before, to 13.5+/-1.2 g/ dL (p<0.001 by paired t test) within 3 to 6 months. INTERPRETATION AND CONCLUSIONS: The recognition that autoimmune atrophic gastritis and H. pylori infection may have a significant role in the development of unexplained or refractory IDA in a high proportion of patients should have a strong impact on our daily practice of diagnosing and managing IDA. SN - 1592-8721 UR - https://www.unboundmedicine.com/medline/citation/15921373/Role_of_autoimmune_gastritis_Helicobacter_pylori_and_celiac_disease_in_refractory_or_unexplained_iron_deficiency_anemia_ L2 - https://facultyopinions.com/pubmed/15921373 DB - PRIME DP - Unbound Medicine ER -