Helicobacter Pylori and Iron Deficiency Anemia in Children: Case Series and Review of Literature

Abstract

Helicobacter pylori (H. pylori) infection has been described as a possible cause of refractory iron deficiency anemia (IDA) in children. Nevertheless, the relationship between H. pylori infection and IDA in children remains an area of controversy due to the contrasting data in literature. We report a case series of two children who presented with IDA refractory to iron treatment, which reversed only after eradication of H. pylori infection, supporting the causal role of this bacterium in pathogenesis of IDA. In both cases H. pylori presented a high antimicrobial resistance, raising the issue on the importance of considering geographical susceptibility of H. pylori strains when starting empirical treatment and the importance of performing antimicrobial susceptibility testings, in particular if standard empirical therapy fails. The present review gives a complete overview of the literature regarding the relationship between H. pylori and IDA in children, explains the possible pathogenetic mechanisms involved in H. pylori-related IDA and addresses the issue of the high antimicrobial resistance often encountered in H. pylori infection in children.