الفهرس 
AnemiaOnly 14 pages are availabe for public view
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Abstract
Anemia is a widespread public health problem with major consequences for human health as well as social and economic development. The World Health Organization (WHO) estimates that about two billion people in the world are suffering from this disease, and that approximately 50% of all anemic cases are diagnosed as iron deficiency anemia.
Helicobacterpyloriis a gram-negative helical microaerophilicflagellated bacterium found in the sterile gastric mucosa of majority of the world’spopulation.It is consider an important pathogen of pediatric gastroenterology that is acquired in early childhood.
Helicobacter pylori is a highly prevalent, serious and chronic infection that has been associated causally with extra gastric disorders including iron deficiency anemia.
Helicobacter pyloriinfection has even been implicated as a cause of IDA refractory to oral iron treatment. Some patients with refractory IDA have no gastrointestinal symptoms but H. pylori gastritis, as the only cause of their anemia.
Many possible mechanisms have been proposed to explain the relation between H. pylori gastritis and IDA including; H. pylori infection affect the gastric body and initiate the development of atrophic body gastritis that can in turn cause decreased gastric acid secretion and increased intra-gastric pH. H. pylori infection adversely influences the composition of the gastric juice; in terms of its acidity and ascorbate content, both of which are critical for normal iron absorption.
These findings suggest that the physiological mechanisms that are necessary for the absorption of alimentary iron in the duodenal mucosa are impaired in patients with H.pylorigastritis ,also IDA may cause occult gastrointestinal bleeding and competition for dietary iron by the bacteria also possible mechanism.
Aim of the work:
To detect Helicobacter pylori infection in children with iron deficiency anemia and compare them with a control healthy group.
Patients and methods:
The Present study was conducted in pediatric department of Menoufiya University hospital, in the period from May 2012 to September 2014.
To start this study, it is important to obtain a formed written consent from the child’s parents and explain to them the nature and the aim of our study.
This study included 2 groups:
Patient group:
Group I:Includes 30 patients with iron deficiency anemia. they were 15 males and 15 females and their mean age was 6.30 ± 2.78 years,they were further subdivided(after doing the investigations) into two subgroup according to their affection with H. pylori:
Group I a: H. pylori positive children
Group I b: H. pylori negative children. Group II: Includes 10 children with refractory iron deficiency anemia (not respond to optimal treatment of iron therapy), they were 5 males and 5 females and their mean age was 5.30 ± 2.11 years,they were further subdivided(after doing the investigations) into two subgroup according to their affection with H. pylori:
Group II a: H. pylori positive children
Group II b: H. pylori negative children
Control group: includes 25 apparently healthy children comparison.
Patients with bleeding diathesis, hepatosplenomegaly andwhom receiving drugs known to cause gastritis were excluded from the study.
All children included in the study were subjected to:
Full history.
Complete clinical assessment.
Full laboratory investigations: including (CBC , serum iron , total iron binding capacity , serum ferritin , H. pylori IgG antibody in blood , H. pylori stool antigen and stool analysis.
The results: of the present study showed:
As regard the demographic data:
In Group I and Group II there were no significant statistical difference as regard age, sex and habitat between them and the control group.
As regard the anthropometric measurements:
In Group I and Group II There were insignificant statistical difference as regard weight, height and body mass index between them and the control group. As regard the Clinical data of the studied groups:
In Group I and Group II there is significant increase incidence of loss of appetite, decrease effort, recurrent abdominal pain, abdominal distension and pallor than control group , but there is no significant statistical difference as regard intake of dietary iron between the three studied groups.
As Regard the laboratory data of the studied groups:
Complete blood picture in this work: showed that there is significant lower values of CBC parameters in both Group Iand Group II than control group.
Serum iron indicesin this work: showed thatThere is significant decrease in serum iron, serum ferritin, transferring saturation and increase in TIBC in both group I and group II than control group.
Helicobacter pylori infection:In the present study we usedH. Pylori stool Ag test and H. Pylori IgG antibody in blood to detect Helicobacter pylori infection in the children of the study and it is found thatthere is increased incidence of H. pylori infection in group II 50% than in group I 36.7% while there is no H. pylori infection among control group.
Stool analysis:There is significant increase incidence of mal-digestion in both group I and group II more than control group,while there is no statistical difference among the three studied group regarding parasitic infestation.
As Regard thecorrelation between H. Pylori stool antigen and ironparameters:There is significant decrease in Hb, serum iron, serum ferritin, and transferrin saturation in H. pylori stool Ag positive children than in H. pylori stool Ag negative children,and there is increase in TIBC level group II, while there is no significant
statistical difference in iron parameters between H. pylori stool Ag positive and negative children in group I .
Regarding the corrrelation between H. Pyloriinfection and demographic data:There is no significant statistical difference between the both sub-groups; H. Pylori positive and H. Pylori negative patient regarding age, sex and habitat in group Iand group II
Regarding the corrrelation between H. Pyloriinfection and clinical data: There is no significant statistical difference between the both sub-groups; H. Pylori positive and H. Pylori negative children regarding clinical data in both group Iand group II.
Regarding the relation between H. Pylori infection and stool analysis: There is significant increase incidence of mal-digestion in H. pylori negative than H. pylori positive children in group I and group II.