Eradicating H pylori in children increases serum ferritin levels

Eradicating asymptomatic Helicobacter pylori infection in children without iron deficiency does not change iron stores, according to the results of a double-blind, randomized trial published in the Journal of Pediatric Gastroenterology and Nutrition.

However, children in whom H pylori infection is cleared during follow-up have larger increases in serum ferritin levels compared with those in whom the infection persists.

Epidemiologic studies suggest that H pylori infection plays a role in iron deficiency and iron deficiency anemia. The researchers hypothesized that treating H pylori infection in children would improve levels of iron stores (serum ferritin, transferrin saturation, and mean hemoglobin) at follow-up of more than 6 months compared with children who were not treated. They thus enrolled 110 asymptomatic children 3 to 10 years old who were randomized to quadruple treatment to eradicate H pylori (lansoprazole, amoxicillin, clarithromycin, and tinidazole), iron supplementation, H pylori eradication plus iron supplementation, or placebo.

Forty-four percent of children receiving H pylori eradication treatment (with or without iron) had their infections eradicated compared with 12% of children receiving placebo. Neither intent-to-treat or per protocol analysis showed a statistically significant effect of any treatment arm on levels of markers of iron stores.

Among only the children who cleared their infection, there was a 3-fold increased change in serum ferritin levels-the marker of earliest depletion of iron stores-from baseline (+7.7 ng/mL). The analysis indicates that there is an effect of the infection on the levels of serum ferritin, according to the researchers.

The results indicate that clearing H pylori infection made a difference in the changes observed in serum ferritin, they say.

Cardenas VM, Prieto-Jimenez CA, Mulla ZD, et al. Helicobacter pylori eradication and change in markers of iron stores among non-iron-deficient children in El Paso, Texas: an etiologic intervention study. J Pediatr Gastroenterol Nutr. 2011;52(3);326-332.