Controlled, household-randomized, open-label trial of the effect of treatment of Helicobacter pylori infection on iron deficiency among children in rural Alaska: results at 40 months.
BACKGROUND
Helicobacter pylori infection treatment was found not to reduce the prevalence of iron deficiency or anemia among Alaska Native children at 14 months after treatment initiation. We hypothesized that 14 months was to early to resolve H. pylori-induced gastric damage. Consequently, we conducted a 40-month follow-up.


METHODS
We enrolled 219 children 7-11 years old who had H. pylori infection (as diagnosed by (13)C-labeled urea breath test) and iron deficiency (serum ferritin level, <22.47 pmol/L) in a controlled, household-randomized trial of the effect of treatment of H. pylori on iron deficiency and anemia (hemoglobin level, <115 g/L). At 40 months, 176 children were evaluated.


RESULTS
Forty-four (52%) of 85 children in the intervention group and 53 (58%) of 91 in the control group had iron deficiency (adjusted relative risk [ARR], 0.92 [95% confidence interval {CI}, 0.68-1.26]), versus 4 (5%) and 17(19%), respectively, with both iron deficiency and anemia (ARR, 0.25 [95% CI, 0.09-0.73]). Reinfection occurred among 33 (52%) of 64 children who had cleared their infection. H. pylori-negative children had lower prevalences of iron deficiency (ARR, 0.62 [95% CI, 0.38-1.01]) and iron deficiency and anemia (ARR, 0.22 [95% CI, 0.03-1.50]), compared with H. pylori -positive children.


CONCLUSIONS
The resolution of H. pylori infection for >14 months modestly reduced the prevalence of iron deficiency and substantially reduced the prevalence of iron deficiency and anemia. H. pylori likely plays a casual role in hematological outcomes for some children.
Fagan
Ryan P
RP
Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; and Alaska Division of Public Health, Anchorage, Alaska.
Dunaway
C Eitel
CE
Bruden
Dana L
DL
Parkinson
Alan J
AJ
Gessner
Bradford D
BD
D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000008:administration & dosage / Q000627:therapeutic use*; D000413:Alaska / Q000453:epidemiology; D018798:Anemia, Iron-Deficiency / Q000150:complications* / Q000453:epidemiology / Q000517:prevention & control; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000897:Anti-Ulcer Agents / Q000008:administration & dosage / Q000627:therapeutic use; D002648:Child; D005260:Female; D005296:Ferrous Compounds / Q000008:administration & dosage / Q000627:therapeutic use*; D005500:Follow-Up Studies; D016481:Helicobacter Infections / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D016480:Helicobacter pylori; D006801:Humans; D064747:Lansoprazole; D008297:Male; D015995:Prevalence; D013997:Time Factors
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents; D005296:Ferrous Compounds; D064747:Lansoprazole; C020748:ferrous sulfate