Helicobacter pylori Infection and Iron Deficiency Anemia in Children: Exploring the Link and Implications for Early Intervention

Ziteng Wang¹Wentao Tan²Huanhuan XIONG³Jiali Huang²Herui Wei¹Mengqi Li¹Jing Luo⁴Wen An¹Jiali Ma¹Lingling He¹Fan Xiao¹Hongshan Wei^1*

• ¹Gastroenterology, Beijing Ditan Hospital, Capital Medical University, Beijing, Beijing Municipality, China
• ²Gastroenterology, Beijing Shijitan Hospital, Capital Medical University, Beijing, Beijing Municipality, China
• ³Rheumatology and Immunology, Zhumadian Central Hospital, Zhumadian, China
• ⁴Gastroenterology, Peking University Ditan Teaching Hospital, Beijing, China

This study investigates the association between Helicobacter pylori (H. pylori) infection and iron deficiency (ID) as well as its potential link to iron deficiency anemia (IDA) in children. As of August 2024, we conducted a comprehensive literature review using the Embase, PubMed, Web of Science, Ovid Medline, and Cochrane databases to compare the risk of IDA in patients with and without H. pylori infection. The Newcastle-Ottawa Quality Assessment Scale was used to assess the methodological quality of the included studies. Odds ratios (ORs) and 95% confidence intervals (CIs) were extracted from the studies, and data were transformed for meta-analysis. Heterogeneity was evaluated using the I ² statistic, and homogeneity was tested with the chi-square test. If the I ² value was 50% or greater, a random-effects model was applied; if the I²value was below 50%, a fixed-effects model was used. The meta-regression was performed to explore the potential sources of heterogeneity. Additionally, a meta-analysis was conducted to assess the changes in hemoglobin and ferritin concentrations before and after H. pylori eradication. We analyzed data from patients across 14 countries. Our findings reveal that individuals infected with H. pylori have a higher likelihood of developing ID compared to those uninfected, with an OR=1.52 (P<0.00001, 95% CI 1.32-1.74, I 2 =44%). The risk of IDA is also higher in patients with H. pylori, with an OR=1.83 (P=0.05, 95% CI 1.01-3.33, I ² =67%). Conversely, the overall effect of H. pylori infection on anemia is minimal, with an OR=0.94 (P=0.64, 95% CI 0.73-1.21, I ² =96%) . Meta-regression results suggest that age is the main source of heterogeneity. A meta-analysis of treatment-related randomized controlled trials revealed that combining iron supplementation with H. pylori eradication therapy significantly raised ferritin levels, with an OR=0.86 (P = 0.02, 95% CI 0.14-1.57, I² = 89%). Hemoglobin levels also showed an increase, with an OR=0.47 (P = 0.04, 95% CI 0.01-0.93, I² = 75%). In children, there is a significant association between H. pylori infection and both ID and IDA. Additionally, the eradication of H. pylori has been shown to lead to an improvement in iron stores.