Anémie ferriprive inexpliquée et gastrite chronique à Helicobacter pylori

Abstract

Summary Iron-deficiency anemia remains unexplained after upper and lower endoscopies in about 35% of the cases. Association between iron-deficiency anemia and atrophic gastritis has been recognized for many years. As early as 1993, well-documented clinical cases, mainly of children and adolescents, have shown that iron-deficiency anemia (in particular, iron-resistant anemia) could be corrected by eradication of Helicobacter pylori, even without associated iron supplementation. It seems that the main mechanism is iron malabsorption. Indeed, absorption of iron necessitates a reduction of the ferric to ferrous form, which is dependent upon the pH of gastric juice and ascorbic acid. Recent studies have shown that patients with an association of pangastritis (inflammatory rather than atrophic) and unexplained iron-deficiency anemia had increased intragastric pH and lower intragastric and plasma levels of ascorbic acid compared to patients with unexplained iron-deficiency anemia without H. pylori-associated gastritis and patients with H. pylori-associated gastritis but without anemia. Based on the available evidence, testing and treatment of persons with pangrastritis and unexplained iron-deficiency anemia for H. pylori infection was recommended by the experts at the latest Maastricht III European consensus conference.