title: Helicobacter pylori-associated hypochlorhydria in children, and development of iron deficiency.
abstract: OBJECTIVE
  Acute Helicobacter pylori infection is associated with transient hypochlorhydria. In H pylori-associated atrophy, hypochlorhydria has a role in iron deficiency (ID) through changes in the physiology of iron-complex absorption. The aims were to evaluate the association between H pylori-associated hypochlorhydria and ID in children.
  
  
  METHODS
  Symptomatic children (n=123) were prospectively enrolled. Blood, gastric juice and gastric biopsies were taken, respectively, for haematological analyses, pH assessment and H pylori determination, and duodenal biopsies for exclusion of coeliac disease. Stool samples were collected for parasitology/microbiology. Thirteen children were excluded following parasitology and duodenal histopathology, and five due to impaired blood analysis.
  
  
  RESULTS
  Ten children were hypochlorhydric (pH>4) and 33 were H pylori positive. In H pylori-positive children with pH>4 (n=6) serum iron and transferrin saturation levels % were significantly lower (p<0.01) than H pylori-positive children with pH≤4. No differences in ferritin, or total iron binding capacity, were observed. In H pylori-negative children with pH>4, iron and transferrin saturation were not significantly different from children with pH≤4.
  
  
  CONCLUSIONS
  Low serum iron and transferrin in childhood H pylori infection is associated with hypochlorhydria. In uninfected children, hypochlorhydria was not associated with altered serum iron parameters, indicating a combination of H pylori infection and/or inflammation, and hypochlorhydria has a role in the aetiology of ID. Although H pylori-associated hypochlorhydria is transient during acute gastritis, this alters iron homeostasis with clinical impact in developing countries with a high H pylori prevalence.
authors.affiliation: Division of Paediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Paul R
authors.initials: PR
authors.lastname: Harris
authors.forename: Carolina A
authors.initials: CA
authors.lastname: Serrano
authors.forename: Andrea
authors.initials: A
authors.lastname: Villagrán
authors.forename: Marjorie M
authors.initials: MM
authors.lastname: Walker
authors.forename: Melanie
authors.initials: M
authors.lastname: Thomson
authors.forename: Ignacio
authors.initials: I
authors.lastname: Duarte
authors.forename: Henry J
authors.initials: HJ
authors.lastname: Windle
authors.forename: Jean E
authors.initials: JE
authors.lastname: Crabtree
mesh_terms: D000126:Achlorhydria / Q000097:blood* / Q000175:diagnosis / Q000382:microbiology*; D000293:Adolescent; D000367:Age Factors; D001706:Biopsy; D016009:Chi-Square Distribution; D002648:Child; D016099:Endoscopy, Gastrointestinal; D005243:Feces / Q000382:microbiology; D005260:Female; D005745:Gastric Acidity Determination; D005750:Gastric Juice / Q000378:metabolism / Q000382:microbiology; D005753:Gastric Mucosa / Q000378:metabolism*; D016481:Helicobacter Infections / Q000150:complications / Q000175:diagnosis / Q000382:microbiology*; D016480:Helicobacter pylori / Q000302:isolation & purification*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007501:Iron / Q000097:blood; D000090463:Iron Deficiencies; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013270:Stomach / Q000382:microbiology*; D014168:Transferrin / Q000032:analysis
chemical_list: D014168:Transferrin; D007501:Iron