Jump to ContentJump to Main Navigation
Show Summary Details
More options …

Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

Editor-in-Chief: Plebani, Mario

Ed. by Gillery, Philippe / Greaves, Ronda / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Payne, Deborah A. / Schlattmann, Peter


IMPACT FACTOR 2018: 3.638

CiteScore 2018: 2.44

SCImago Journal Rank (SJR) 2018: 1.191
Source Normalized Impact per Paper (SNIP) 2018: 1.205

Online
ISSN
1437-4331
See all formats and pricing
More options …
Volume 57, Issue 7

Issues

Iron status determination in individuals with Helicobacter pylori infection: conventional vs. new laboratory biomarkers

Dietmar Enko
  • Corresponding author
  • Institute of Clinical Chemistry and Laboratory Medicine, General Hospital Steyr, Steyr, Austria
  • Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Helga Wagner / Gernot Kriegshäuser
  • Institute of Clinical Chemistry and Laboratory Medicine, General Hospital Steyr, Steyr, Austria
  • Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Julia Wögerer
  • Institute of Clinical Chemistry and Laboratory Medicine, General Hospital Steyr, Steyr, Austria
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Gabriele Halwachs-Baumann
  • Institute of Clinical Chemistry and Laboratory Medicine, General Hospital Steyr, Steyr, Austria
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Wolfgang J. Schnedl / Sieglinde Zelzer
  • Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Günter Fauler
  • Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Harald Mangge
  • Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Herrmann Markus
  • Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Andreas Meinitzer
  • Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2019-01-07 | DOI: https://doi.org/10.1515/cclm-2018-1182

Abstract

Background

Helicobacter pylori has been associated with iron deficiency (ID). This study is aimed at investigating ID with conventional (ferritin, transferrin saturation [TSAT]) and new biomarkers (soluble transferrin receptor [sTfR], sTfR/log ferritin, reticulocyte hemoglobin content [CHr], hepcidin-25) in patients sub-grouped by the presence or absence of H. pylori infection.

Methods

In total, 200 consecutive outpatients, who were referred for the H. pylori 13C-urea breath test (13C-UBT), underwent blood testing for ID. Additionally, Thomas-plot (TP)-analyses (sTfR/log ferritin, CHr) were calculated.

Results

Fifty-three and 147 individuals were found with and without H. pylori infection, respectively. Patients with H. pylori infection showed a higher sTfR concentration (p<0.02) and a higher sTfR/log ferritin ratio (p<0.05). Based on a ferritin <30 μg/L and/or a TSAT <20%, 25/53 (47.2%) patients with H. pylori infection and 63/147 (42.9%) without H. pylori infection showed ID. Based on TP-analyses, 10/53 (18.9%) patients with and 17/147 (11.6%) without H. pylori infection were identified with ID. Completed eradication therapy tended to be associated with functional ID.

Conclusions

Helicobacter pylori infection was associated with significantly higher plasma sTfR concentrations and sTfR/log ferritin ratios. Patients with H. pylori eradication therapy were more often detected with functional ID compared to patients without eradication therapy, when using the new biomarkers.

This article offers supplementary material which is provided at the end of the article.

Keywords: biomarkers; Helicobacter pylori; iron deficiency; iron metabolism

References

  • 1.

    Eusebi LH, Zagari RM, Bazzoli F. Epidemiology of Helicobacter pylori infection. Helicobacter 2014;19(Suppl 1):1–5.CrossrefPubMedGoogle Scholar

  • 2.

    Savarino V, Vigneri S, Celle G. The 13C urea breath test in the diagnosis of Helicobacter pylori infection. Gut 1999;45(Suppl 1):I18–22.CrossrefGoogle Scholar

  • 3.

    Enko D, Kriegshäuser G. Functional 13C-urea and glucose hydrogen/methane breath tests reveal significant association of small intestinal bacterial overgrowth in individuals with active Helicobacter pylori infection. Clin Biochem 2017;50:46–9.CrossrefPubMedGoogle Scholar

  • 4.

    Muhsen K, Cohen D. Helicobacter pylori infection and iron stores: a systematic review and meta-analysis. Helicobacter 2008;13:323–40.CrossrefPubMedWeb of ScienceGoogle Scholar

  • 5.

    Huang X, Qu X, Yan W, Huang Y, Cai M, Hu B, et al. Iron deficiency anaemia can be improved after eradication of Helicobacter pylori. Postgrad Med J 2010;86:272–8.PubMedCrossrefWeb of ScienceGoogle Scholar

  • 6.

    Ciacci C, Sabbatini F, Cavallaro R, Castiglione F, Di Bella S, Iovino P, et al. Helicobacter pylori impairs iron absorption in infected individuals. Dig Liver Dis 2004;36:455–60.PubMedCrossrefGoogle Scholar

  • 7.

    Berg G, Bode G, Blettner M, Boeing H, Brenner H. Helicobacter pylori infection and serum ferritin: a population-based study among 1806 adults in Germany. Am J Gastroenterol 2001;96:1014–8.CrossrefPubMedGoogle Scholar

  • 8.

    Cardenas VM, Mulla ZD, Ortiz M, Graham DY. Iron deficiency and Helicobacter pylori infection in the United States. Am J Epidemiol 2006;163:127–34.CrossrefPubMedGoogle Scholar

  • 9.

    Parkinson AJ, Gold BD, Bulkow L, Wainwright RB, Swaminathan B, Khanna B, et al. High prevalence of Helicobacter pylori in Alaska native population and association with low serum ferritin levels in young adults. Clin Diagn Lab Immunol 2000;7:885–8.PubMedGoogle Scholar

  • 10.

    Urrechaga E, Borgue L, Escanero JF. Biomarkers of hypochromia: the contemporary assessment of iron status and erythropoiesis. Biomed Res Int 2013;2013:603786.Web of SciencePubMedGoogle Scholar

  • 11.

    Ferrari M, Mistura L, Patterson E, Sjöström M, Díaz LE, Stehle P, et al. Evaluation of iron status in European adolescents through biochemical iron indicators: the HELENA study. Eur J Clin Nutr 2011;65:340–9.CrossrefPubMedWeb of ScienceGoogle Scholar

  • 12.

    Enko D, Wagner H, Kriegshäuser G, Kimbacher C, Stolba R, Halwachs-Baumann G. Assessment of human iron status: a cross-sectional study comparing the clinical utility of different laboratory biomarkers and definitions of iron deficiency in daily practice. Clin Biochem 2015;48:891–6.Web of SciencePubMedCrossrefGoogle Scholar

  • 13.

    Muñoz M, Villar I, García-Erce JA. An update on iron physiology. World J Gastroenterol 2009;15:4617–26.CrossrefWeb of SciencePubMedGoogle Scholar

  • 14.

    Thomas C, Thomas L. Biochemical markers and hematologic indices in the diagnosis of functional iron deficiency. Clin Chem 2002;48:1066–76.Google Scholar

  • 15.

    Enko D, Wagner H, Kriegshäuser G, Kimbacher C, Stolba R, Worf E, et al. Hepcidin-25 vs. conventional clinical biomarkers in the diagnosis of functional iron deficiency. Eur J Haematol 2015;95:507–13.Web of ScienceCrossrefGoogle Scholar

  • 16.

    Kawakami E, Machado RS, Reber M, Patrício FR. 13 C-urea breath test with infrared spectroscopy for diagnosing Helicobacter pylori infection in children and adolescents. J Pediatr Gastroenterol Nutr 2002;35:39–43.PubMedCrossrefGoogle Scholar

  • 17.

    Enko D, Wallner F, von-Goedecke A, Hirschmugl C, Auersperg V, Halwachs-Baumann G. The impact of an algorithm-guided management of preoperative anemia in perioperative hemoglobin level and transfusion of major orthopedic surgery patients. Anemia 2013;2013:641876.PubMedGoogle Scholar

  • 18.

    Miernyk K, Bruden D, Zanis C, McMahon B, Sacco F, Hennessy T, et al. The effect of Helicobacter pylori infection on iron stores and iron deficiency in urban Alaska Native adults. Helicobacter 2013;18:222–8.PubMedCrossrefWeb of ScienceGoogle Scholar

  • 19.

    Mulayim B, Celik NY, Yanik FF. Helicobacter pylori infection detected by 14C-urea breath test is associated with iron deficiency anemia in pregnant women. J Obstet Gynaecol Res 2008;34:980–5.PubMedGoogle Scholar

  • 20.

    Burns M, Muthupalani S, Ge Z, Wang TC, Bakthavtchalu V, Cunningham C, et al. Helicobacter pylori infection induces anemia, depletes serum iron storage, and alters local iron-related and adult brain gene expression in male INS-GAS mice. PLoS One 2015;10:e0142630.CrossrefWeb of SciencePubMedGoogle Scholar

  • 21.

    Choi JW. Serum-soluble transferrin receptor concentrations in Helicobacter pylori-associated iron-deficiency anemia. Ann Hematol 2006;85:735–7.PubMedCrossrefGoogle Scholar

  • 22.

    Infusino I, Braga F, Dolci A, Panteghini M. Soluble transferrin receptor (sTfR) and sTfR/log ferritin index for the diagnosis of iron-deficiency anemia. A meta-analysis. Am J Clin Pathol 2012;138:642–9.CrossrefGoogle Scholar

  • 23.

    Feelders RA, Kuiper-Kramer EP, van Eijk HG. Structure, function and clinical significance of transferrin receptors. Clin Chem Lab Med 1999:37:1–10.CrossrefPubMedGoogle Scholar

  • 24.

    Yokota S, Konno M, Mino E, Sato K, Takahashi M, Fujii N. Enhanced Fe ion-uptake activity in Helicobacter pylori strains isolated from patients with iron-deficiency anemia. Clin Infect Dis 2008;46:e31–3.Web of ScienceCrossrefPubMedGoogle Scholar

  • 25.

    Lee JH, Choe YH, Choi YO. The expression of iron-repressible outer membrane proteins in Helicobacter pylori and its association with iron deficiency anemia. Helicobacter 2009;14:36–9.Web of SciencePubMedCrossrefGoogle Scholar

  • 26.

    Weiss G, Goodnough LT. Anemia of chronic disease. N Engl J Med 2005;352:1011–23.PubMedCrossrefGoogle Scholar

  • 27.

    Ledochowski M, Widner B, Fuchs D. Helicobacter pylori and chronic immune activation. Am Heart J 2000;139:925–6.PubMedCrossrefGoogle Scholar

  • 28.

    Ledochowski M, Murr C. Lass-Flörl C, Fuchs D. Helicobacter pylori infection and neopterin. Pteridines 2001;12:126–9.Google Scholar

  • 29.

    Campuzano-Maya G. Hematologic manifestations of Helicobacter pylori infection. World J Gastroenterol 2014;20:12818–38.PubMedCrossrefWeb of ScienceGoogle Scholar

  • 30.

    Sato Y, Yoneyama O, Azumaya M, Takeuchi M, Sasaki SY, Yokoyama J, et al. The relationship between iron deficiency in patients with Helicobacter pylori-infected nodular gastritis and the serum prohepcidin level. Helicobacter 2015;20:11–8.Web of SciencePubMedCrossrefGoogle Scholar

  • 31.

    Chen ST, Ni YH, Li CC, Liu SH. Hepcidin correlates with interleukin-1β and interleukin-6 but not iron deficiency in children with Helicobacter pylori infection. Pediatr Neonatol 2018;59:611–7.CrossrefWeb of SciencePubMedGoogle Scholar

  • 32.

    Emiralioglu N, Yenicesu I, Sari S, Egritas O, Poyraz A, Pasaoglu OT, et al. An insight into the relationships between prohepcidin, iron deficiency anemia, and interleukin-6 values in pediatric Helicobacter pylori gastritis. Eur J Pediatr 2015;174:903–10.PubMedCrossrefWeb of ScienceGoogle Scholar

  • 33.

    Leong WI, Lönnerdal B. Hepcidin, the recently identified peptide that appears to regulate iron absorption. J Nutr 2004;134:1–4.CrossrefPubMedGoogle Scholar

  • 34.

    Sapmaz F, Basyiğit S, Kalkan IH, Kisa Ü, Kavak EE, Güliter S. The impact of Helicobacter pylori eradication on serum hepcidin-25 level and iron parameters in patients with iron deficiency anemia. Wien Klin Wochenschr 2016;128:335–40.CrossrefPubMedWeb of ScienceGoogle Scholar

  • 35.

    Maruyama M, Kamimura K, Hoshiyama A, Hoshiyama K, Hoshiyama M, Hoshiyama Y, et al. Effect of Helicobacter pylori eradication on elder cases: Observational study in community-based medicine. World J Clin Cases 2017;16:412–8.Web of ScienceGoogle Scholar

  • 36.

    Chen LH, Luo HS. Effects of H. pylori therapy on erythrocytic and iron parameters in iron deficiency anemia patients with H. pylori-positive chronic gastritis. World J Gastroenterol 2007;13:5380–3.CrossrefGoogle Scholar

  • 37.

    McColl KE. Effect of proton pump inhibitors on vitamins and iron. Am J Gastroenterol 2009;104(Suppl 2):S5–9.Web of ScienceCrossrefPubMedGoogle Scholar

  • 38.

    Sharma VR, Brannon MA, Carloss EA. Effect of omeprazole on oral iron replacement in patients with iron deficiency anemia. South Med J 2004;97:887–9.PubMedCrossrefGoogle Scholar

  • 39.

    Hutchinson C, Geissler CA, Powell JJ, Bomford A. Proton pump inhibitors suppress absorption of dietary non-haem iron in hereditary haemochromatosis. Gut 2007;56:1291–5.Web of ScienceCrossrefPubMedGoogle Scholar

About the article

Corresponding author: Dietmar Enko, MD, Institute of Clinical Chemistry and Laboratory Medicine, General Hospital Steyr, Sierningerstr. 170, 4400 Steyr, Austria; and Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria, Phone: +43 50554 66 25307, Fax: +43 50554 66 25304


Received: 2018-11-03

Accepted: 2018-12-05

Published Online: 2019-01-07

Published in Print: 2019-06-26


Author contributions: DE wrote the manuscript. All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

Research funding: None declared.

Employment or leadership: None declared.

Honorarium: None declared.

Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.


Citation Information: Clinical Chemistry and Laboratory Medicine (CCLM), Volume 57, Issue 7, Pages 982–989, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: https://doi.org/10.1515/cclm-2018-1182.

Export Citation

©2019 Walter de Gruyter GmbH, Berlin/Boston.Get Permission

Supplementary Article Materials

Comments (0)

Please log in or register to comment.
Log in