Helicobacter pylori infection, iron absorption, and gastric acid secretion in Bangladeshi children.
BACKGROUND
Nonheme-iron absorption requires an acidic milieu. Reduced gastric acid output as a consequence of Helicobacter pylori infection could be an important limiting factor for iron absorption.


OBJECTIVE
We measured gastric acid output and iron absorption from a non-water-soluble iron compound (ferrous fumarate) and a water-soluble iron compound (ferrous sulfate) in children with and without H. pylori infection.


METHODS
Gastric acid output was quantified before (basal acid output, or BAO) and after pentagastrin stimulation (stimulated acid output, or SAO) in 2-5-y-old children with iron deficiency anemia who were (n = 13) or were not (n = 12) infected with H. pylori. Iron absorption was measured by using a double-stable-isotope technique. H. pylori-infected children were studied before and after eradication therapy.


RESULTS
BAO and SAO were significantly lower in the H. pylori-infected children (0.2 +/- 0.2 and 1.6 +/- 0.9 mmol/h, respectively) than in the uninfected children (0.9 +/- 0.7 and 3.1 +/- 0.9 mmol/h, respectively; P = 0.01 and P < 0.005). BAO and SAO improved to 0.8 +/- 1.3 and 3.3 +/- 2.4 mmol/h, respectively, after therapy. Iron absorption from ferrous sulfate was significantly greater than that from ferrous fumarate both before (geometric : 19.7% compared with 5.3%; P < 0.0001) and after (22.5% compared with 6.4%; P < 0.0001) treatment in H. pylori-infected children. Corresponding values for uninfected children were 15.6% and 5.4%, respectively (P < 0.001; n = 12).


CONCLUSIONS
Iron absorption from ferrous fumarate was significantly lower than that from ferrous sulfate in both H. pylori-infected and uninfected Bangladeshi children. Treatment of H. pylori infection improved gastric acid output but did not significantly influence iron absorption. The efficacy of ferrous fumarate in iron fortification programs to prevent iron deficiency in young children should be evaluated.
Sarker
Shafiqul A
SA
International Centre for Diarrhoeal Disease Research, Bangladesh: Centre for Health and Population Research, Mohakali, Dhaka, Bangladesh. sasarker@icddrb.org
Davidsson
Lena
L
Mahmud
Hasan
H
Walczyk
Thomas
T
Hurrell
Richard F
RF
Gyr
Niklaus
N
Fuchs
George J
GJ
D018798:Anemia, Iron-Deficiency / Q000378:metabolism* / Q000517:prevention & control; D001459:Bangladesh; D001682:Biological Availability; D002675:Child, Preschool; D005260:Female; D005296:Ferrous Compounds / Q000493:pharmacokinetics; D005527:Food, Fortified; D005744:Gastric Acid / Q000378:metabolism*; D005745:Gastric Acidity Determination; D016481:Helicobacter Infections / Q000188:drug therapy / Q000503:physiopathology*; D016480:Helicobacter pylori; D006801:Humans; D007408:Intestinal Absorption; D007501:Iron / Q000493:pharmacokinetics*; D008297:Male; D016896:Treatment Outcome
D005296:Ferrous Compounds; C020748:ferrous sulfate; D007501:Iron; C031621:ferrous fumarate