Can Heliobacter pylori Infection without Erosions or Ulcer Cause Anemia?

Abstract

Purpose:H. pylori infection has been associated with anemia, however, it is not well understood whether H. pylori can cause anemia without evidence of gastric erosion/ulcer. We set out to determine whether H. pylori infection without endoscopic mucosal lesions can cause microcytic anemia. Methods: Pathology database was queried and all consecutive patients who had H. pylori infection on their gastric biopsies between Jan. 2007 and April 2008 were identified. Laboratory database was queried for CBC result and then medical charts of those patients who had CBC result within 120 days of their EGD were reviewed to look for anemia and potential causes of anemia. Results: We identified a total of 306 consecutive patients who had H. pylori infection in their gastric biopsies. One hundred thirty-seven patients were excluded (no recent CBC, N = 124; hematological causes for anemia, N = 13). Eighty one of the remaining 169 patients with H. pylori (48%) had anemia –30/51 (59%) males and 51/118 (43%) females. There was no cause of anemia in 21 of the 81 anemic subjects. Thus, 21/169 (12.4%) of anemic patients with H. pylori infection [ages 33 to 78] had anemia of unknown etiology. Conclusion: Our data suggests that H. pylori infection without endoscopic mucosal breakdown can be associated with anemia. Thus, routine gastric biopsy may be warranted when EGD is done as part of the investigation of anemia. Further prospective studies are needed to validate our retrospective study and determine the cost-effectiveness of routine gastric biopsy in patients with anemia of unknown cause.