title: Pervasive occult gastrointestinal bleeding in an Alaska native population with prevalent iron deficiency. Role of Helicobacter pylori gastritis.
abstract: OBJECTIVE
  To confirm prevalent iron deficiency among Yupik Eskimos living in Alaska and to explore the frequency of and potential lesions accounting for occult gastrointestinal bleeding.
  
  
  METHODS
  Descriptive survey.
  
  
  METHODS
  Rural Arctic community.
  
  
  METHODS
  A total of 140 adult volunteers from 3 villages in the Yukon-Kuskokwim Delta region of western Alaska.
  
  
  METHODS
  Daily iron intake, hematologic and biochemical indexes of iron status, fecal hemoglobin levels, stool parasites, and endoscopic findings.
  
  
  RESULTS
  While dietary iron intake by Yupiks was similar to that of a reference population, iron deficiency prevalence was increased 13-fold in Yupik men and 4-fold in Yupik women. Fecal hemoglobin levels were elevated in 90% of subjects contrasted with only 4% of a reference group; median levels were 5.9 and 0.5 mg of hemoglobin per gram of stool, respectively. Among 70 Yupik subjects with elevated fecal hemoglobin levels who had endoscopy performed, 68 (97%) had an abnormal gastric appearance consisting of erythema, mucosal thickening, diffuse mucosal hemorrhages, erosions, or ulcerations. Gastric biopsies revealed chronic active gastritis with associated Helicobacter pylori in 68 (99%) of 69. No other hemorrhagic gastrointestinal disease was detected.
  
  
  CONCLUSIONS
  Based on this study sample, occult gastrointestinal bleeding appears to be pervasive in the Yupik population and likely underlies the prevalent iron deficiency. An atypical hemorrhagic gastritis associated with H pylori infection is present almost universally and may represent the bleeding source.
authors.affiliation: Division of Nutrition, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Ga, USA.
authors.forename: R
authors.initials: R
authors.lastname: Yip
authors.forename: P J
authors.initials: PJ
authors.lastname: Limburg
authors.forename: D A
authors.initials: DA
authors.lastname: Ahlquist
authors.forename: H A
authors.initials: HA
authors.lastname: Carpenter
authors.forename: A
authors.initials: A
authors.lastname: O'Neill
authors.forename: D
authors.initials: D
authors.lastname: Kruse
authors.forename: S
authors.initials: S
authors.lastname: Stitham
authors.forename: B D
authors.initials: BD
authors.lastname: Gold
authors.forename: E W
authors.initials: EW
authors.lastname: Gunter
authors.forename: A C
authors.initials: AC
authors.lastname: Looker
authors.forename: A J
authors.initials: AJ
authors.lastname: Parkinson
authors.forename: E D
authors.initials: ED
authors.lastname: Nobmann
authors.forename: K M
authors.initials: KM
authors.lastname: Petersen
authors.forename: M
authors.initials: M
authors.lastname: Ellefson
authors.forename: S
authors.initials: S
authors.lastname: Schwartz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000413:Alaska / Q000453:epidemiology; D002908:Chronic Disease; D016145:Endoscopy, Digestive System; D005243:Feces; D005260:Female; D005756:Gastritis / Q000150:complications / Q000208:ethnology / Q000382:microbiology*; D006471:Gastrointestinal Hemorrhage / Q000150:complications / Q000208:ethnology* / Q000209:etiology; D016481:Helicobacter Infections / Q000150:complications* / Q000208:ethnology; D016480:Helicobacter pylori / Q000302:isolation & purification; D006403:Hematologic Tests; D006801:Humans; D004930:Inuit; D000090463:Iron Deficiencies; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D015995:Prevalence