0847 Helicobacter as a cause of refractory iron deficiency anaemia in paediatrics

In a fairly recent retrospective review from Italy, data on 238 iron-deficient (ID) subjects of both sexes between the ages of ±7 months and 16 years were analysed to determine causes and best treatment of iron deficiency anaemia (IDA). Inadequate iron intake was the cause of ID or IDA in 59 of them from the first months of life to adolescence. Blood loss linked to cow's milk intolerance was the cause of ID or IDA in 37 younger children. Meckel's diverticulum (6 cases), reflux oesophagitis (10 cases), and drugs such as aspirin (11 cases) induced bleeding with ID or IDA in both children and adolescents, with polymenorrhea responsible for ID or IDA in adolescent girls (16 cases). Coelic disease (CD)(37 cases), Helicobacter pylori (Hp) infection (39 cases), Hp and CD (8 cases) and enteromonas infection (15 cases), were causes of ID or IDA in patients across a wide age range, particularly if associated with malabsorption, with unresponsiveness to iron therapy a notable feature. The authors concluded that iron replacement therapy is not always required and should not be prescribed until the diagnosis is certain. This association with Hp infection has been noted by others who also found that the eradication of Hp was associated with stable normalization of iron stores. Helicobacter infection may be involved in cases of IDA of unknown origin, and the eradication of Hp is associated with the resolution of anemia. Refractoriness to iron replacement has been the experience of several investigators, and while some concur with the latter conclusion (i.e. Hp eradication alone may be sufficient to ameliorate the situation), others have found that the combination of triple therapy for Hp infection plus iron leads to quicker resolution than either treatment alone. While the Hp infection may be relatively or absolutely asymptomatic in some children, it will be evident on testing or gastroscopy.

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