الفهرس 
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Abstract
Iron deficiency anemia (IDA) affects approximately 30% of the world’s population. Although more prevalent in children and neonates, IDA remains extremely common in the adult population. In Egypt, 51.3% of pregnant women and 49% of children have IDA. The prevalence varies greatly according to age, gender, race, and ethnicity. In premenopausal women, menstrual blood loss and pregnancy-related iron losses account for most IDA diagnoses. Nevertheless, occult bleeding from the gastrointestinal (GI) tract is the leading cause for IDA in men and postmenopausal women.
Helicobacter pylori (H. pylori) is highly adapted to the gastric environment where it lives within or beneath the gastric mucous layer. The bacterium generally does not invade gastro-duodenal tissue. Instead, it renders the underlying mucosa more vulnerable to acid peptic damage by disrupting the mucous layer, liberating enzymes and toxins, and adhering to the gastric epithelium. In addition, the host immune response to H. pylori incites an inflammatory reaction which further perpetuates tissue injury. The chronic inflammation induced by H. pylori upsets gastric acid secretary physiology to varying degrees and leads to chronic gastritis which, in most individuals is asymptomatic and does not progress. In some cases, however, altered gastric secretion coupled with tissue injury leads to peptic ulcer disease, while in other cases, gastritis progresses to atrophy, intestinal metaplasia, and eventually gastric carcinoma or rarely, due to persistent immune stimulation of gastric lymphoid tissue, gastric lymphoma. As a result, the pathophysiology of H. pylori infection and its eventual clinical outcome should be viewed as a complex interaction between the host and the bacterium. This interaction is influenced by the environment and modulated by a number of largely as yet unidentified factors.
Iron deficiency anemia is a common health problem in the general population. Similarly, H. pylori is a common gastrointestinal tract infection that affects a majority of the population. Guidelines on iron deficiency anemia have confirmed the etiological role of H. pylori, but the relationship remains controversial.
The role of H pylori in the causation of IDA is of considerable current interest. Major population surveys conducted over diverse geographic areas indicate that H pylori positivity is associated with an increased prevalence of iron deficiency, and meta- analysis of 19 observational epidemiologic studies and 6 interventional trials revealed an increased risk for IDA with a pooled odds ratio (OR) of 2.8 among H pylori-infected subjects.
Our study is cross-sectional, case control study conducted to assess the causal association between H.pylori infection and unexplained iron deficiency anemia. The study sample comprised 70 participants. They were selected from Ain Shams university hospital from inpatient wards and outpatient clinics. The studied sample is divided into2 groups: 50 patient with unexplained iron deficiency anemia and 20 healthy subjects with no apparent evidence of disease after full medical history, physical examination and complete blood count.
Any patient with obvious cause of iron deficiency anemia, blood loss (either gastro intestinal or gynecological), mal-absorption, or malignancy and any patient with positive occult blood in stool were excluded from the study. all patient underwent thorough medical history and clinical examination , routine laboratory investigations ,compete blood count, erythrocyte sedimentation rate (ESR), iron study, stool examination for occult blood ,and stool examination for H.pylori antigen .
Our study included
50 patient with unexplained IDA with age ranging from 19 to 77 years (39.6 +/- 14.5) years, among them 86% were female (n=43) and 14% were male (n=7) , with hemoglobin level ranging from 3.6 to 11 gm/dl (8.9 +/-2.1), serum ferritin ranging from 1.5 to 25 µg/dl (10.1 +/- 5.7) ) , MCV ranging from 52 to 79 fl (70.6+/- 6.1),MCH ranging from 15 to 26 pg (20.7 +/- 2.6), serum iron ranging from 3 to 56 µg/dl (21.6+/-10),TIBC ranging from 257 to 586 µg/dl (411+/-64.4),and RBC count ranging from 3.5 to 4.4 x10^6 /mm3 (3.9±0.3)..
20 healthy control with age ranging from 22 to 64 years (35 +/-13.2), among them 45% (n=9) were female and 55% (n=11) were male, with hemoglobin level ranging from 12 to 15 gm/dl (13.1+/-0.9),
Comparing both group there was no significant difference in age distribution, female gender was more common among cases while most of the control group were males, not surprisingly Hb concentration was higher among the control group.
We evaluated H.pylori status in both group by testing for the presence of H.pylori antigen in stool, the prevalence of H.pylori infection was 20% among unexplained IDA group (n=10) and 20% among the control group (n=4), obviously there was no difference between both group. female gender was the only significant risk factor for IDA which is a known fact due to menstrual blood loss.
In our study we re-evaluated the association of H.pylori and IDA among male and postmenopausal female in both group : 17 patient were included from the unexplained IDA group and 13 persons were included from the control group, the prevalence of H.pylori was slightly higher in the un-explained IDA group 29.4% (n=5) compared to 23.1% (n=3) among the control group, however the difference was statistically insignificant, larger samples is needed to yield a statistically significant result among this group.
The result of our study disagreed with other studies which confirmed causal association between H.pylori infection and IDA and this could be explained by many reasons; first, Iron deficiency anemia and H. pylori infections may be a coincidence because both of the diseases are highly prevalent. Moreover, there are many causes that lead to iron deficiency anemia, such as malnutrition, vitamin deficiencies, chronic disorders, infections, excessive drinking of tea and/or coffee, and conditions associated with chronic blood loss. Furthermore, since H. pylori colonization in the gastric mucosa may disturb some functions of the mucosa, it leads to a decrease in iron absorption and increases iron loss and this is an excellent explanation for the results reported in these studies. We also noticed that studies conducted in the Asian region were more likely to have positive results than those conducted in American region, which gave some clues that geographic distribution differences of strains of H. pylori could be one of the reasons why studies have controversial results.