Abstract

Associations observed of Helicobacter pylori infection with haemoglobin levels are inconsistent. We examined associations of H. pylori sero-prevalence and serum pepsinogens (PGs), as non-invasive markers of atrophic gastritis, with haemoglobin levels. A cross-sectional study was undertaken among 654 Jewish and 937 Arab residents of Jerusalem, aged 25–78 years, randomly selected from Israel’s national population registry in age-sex and population strata. Sera were tested for H. pylori IgG, cytotoxin–associated gene A (CagA) antigen IgG antibody and PGs levels. Multivariable models were fitted to account for confounders. Participants with atrophic gastritis (PGI < 30 μg/L or a PGI: PGII < 3.0) had lower haemoglobin levels than those without: beta-coefficient −0.34 (95% CI −0.59, −0.09); in men −0.27 (95% CI −0.67, 0.12), and in women −0.43 (95% CI −0.74, −0.12). Lower haemoglobin levels were noted in persons with CagA antibody than in those H. pylori sero-negative or H. pylori-CagA sero-negative: beta-coefficient −0.14 (95% CI −0.29, 0.01). Anaemia was more common among women and men with than without atrophic gastritis: adjusted OR 2.58 (95% CI 1.48, 4.48) and 1.52 (95% CI 0.59, 3.95), respectively. In conclusion, independent of known correlates, atrophic gastritis and apparently CagA sero-positivity, a marker of H. pylori virulent strains, are associated with lower haemoglobin levels.

Highlights

  • Anaemia is an important public health problem, which usually results from a depletion of body iron stores

  • Anaemia was more prevalent among women (20.3% [95% CI 17.5%, 23.3%]) than men (6.5% [95% CI 5.0%, 8.3%]), P < 0.001

  • We examined associations of H. pylori immunoglobulin G (IgG) sero-prevalence, cytotoxin-associated gene A (CagA) IgG sero-positivity and serum PGs, as non-invasive markers of atrophic gastritis, with haemoglobin levels and anaemia, in men and women of two ethnic groups in a general population

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Summary

Introduction

Anaemia is an important public health problem, which usually results from a depletion of body iron stores. H. pylori, a gram negative bacterium that colonizes the gastric mucosa and causes chronic gastritis[2], is the main cause of gastric and duodenal ulcers, and an established risk factor for gastric cancer and MALT lymphoma[2,3,4,5] These conditions usually develop in adulthood, only in a subset of infected individuals[2]. The aims of the current study were to examine associations of H. pylori immunoglobulin G (IgG) sero-prevalence, CagA IgG sero-positivity and serum PGs, as non-invasive markers of atrophic gastritis, with two outcome variables: haemoglobin levels (continuous variable) and anaemia, in a population-based sample of adult men and women

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