Ashorn M, Ruuska T, Mäkipernaa A
Dept. of Pediatrics, Tampere University Hospital, Finland.
Scand J Gastroenterol. 2001 Jul;36(7):701-5. doi: 10.1080/003655201300191950.
Both iron deficiency anaemia and Helicobacter pylori infection are rare in developed countries. A possible connection has been suggested between these two diseases and our aim was to define the clinical picture and to study the effect of bacterial eradication in H. pylori colonized children with severe anaemia.
Eight children with iron deficiency anaemia refractory to iron supplementation were examined with gastroscopy because of suspicion of H. pylori infection. Anaemia was treated with oral ferrous sulphate. Two patients needed blood transfusions. Eradication therapy was given either with combination of colloidal bismuth subcitrate and metronidazole or with omeprazole, clarithromycin and amoxycillin. Eradication was confirmed by urea breath test 4 weeks post-treatment.
H. pylori infection was confirmed histologically and microbiologically in all children, who also presented with chronic, active gastritis. Bacteria were successfully eradicated in 7/8 patients. Correction of haemoglobin values was observed post-treatment, iron stores still being deficient at control in 4/8 children.
Our results suggest that H. pylori might have a role in causing iron deficiency anaemia in school-age children. Screening for H. pylori should be extended to cover those patients with other clinical manifestations than symptoms from gastrointestinal tract.
缺铁性贫血和幽门螺杆菌感染在发达国家均较为罕见。这两种疾病之间可能存在某种联系，我们的目的是明确临床表现，并研究根除幽门螺杆菌对患有严重贫血的幽门螺杆菌定植儿童的影响。
对8名补充铁剂后缺铁性贫血仍未改善的儿童进行胃镜检查，怀疑其感染幽门螺杆菌。贫血采用口服硫酸亚铁治疗。两名患者需要输血。采用枸橼酸铋钾与甲硝唑联合用药或奥美拉唑、克拉霉素和阿莫西林进行根除治疗。治疗4周后通过尿素呼气试验确认根除情况。
所有儿童经组织学和微生物学检查均确诊为幽门螺杆菌感染，且均伴有慢性活动性胃炎。8名患者中有7名细菌被成功根除。治疗后观察到血红蛋白值得到纠正，8名儿童中有4名在复查时铁储备仍不足。
我们的结果表明，幽门螺杆菌可能在学龄儿童缺铁性贫血的发病中起作用。幽门螺杆菌筛查应扩大到覆盖那些有胃肠道以外其他临床表现的患者。
