Serum Ascorbic Acid concentration in Patients with Iron Deficiency Anaemia, Impact of Helicobacter Pylori Gastritis

Introduction: Several clinical reports have demonstrated that H.pylori gastric infection has emerged as a new cause of refractory iron deficiency anemia, unresponsive to iron therapy, and not attributable to usual causes. It is known that most persons who develop chronic H.pylori gastritis will exhibit more prominent gastritis in the antrum than the body. A large percentage of patients with atrophic body gastritis develop iron deficiency anemia.Aim: This study was undertaken to asses the prevalence of H.pylori infection among IDA patients and to evaluate the changes of serum and gastric juice ascorbic acid concentrations as a possible pathogenic mechanism for iron deficiency anemia in patients with H-pylori gastritis.Subject and methods: The study was carried out on 50 individual; they were divided according to the presence of iron deficiency anemia into patient and control groups:Patients group, comprised 30 patients with unexplained IDA it was then subdivided according to the result of H.pylori detection by ultra-rapid urease test into group I which comprised 20 patients who were IDA+ve ,H.pylori +ve and group II that comprised 10 patients with IDA+ve and H.pylori –ve.Control group, it comprised 20 individual who were IDA negative but were suffering from dyspepsia and also according to urease test they were divided into group III which consisted of 8 individual who were IDA –ve,H.pylori +ve and group IV of 12 individual with IDA –ve and H.pylori –ve tests.In all individuals we measured serum and gastric juice ascorbic acid concentrations.Results: Significant increase in the prevalence of H.pylori gastritis in patients group (IDA +ve) than in control groups (IDA –ve). (66.6% Vs 40%)(P < 0.05). Very highly significant decrease in serum ascorbic acid in both group I and III in comparison to IV (P<0.001).Very highly significant decrease in gastric juice ascorbic acid in groups I and III in comparison to groups II and IV respectively(P<0.001).Conclusion and Recommendations:- We have found that there is higher rate of H.pylori infection among patients with unexplained IDA compared with a control group of non anemic individuals.We also found that patients with IDA associated H.pylori gastritis present with reduction in serum and gastric juice ascorbic acid in the form of reduction in its concentrations and that may account for impaired iron absorption and consequent iron deficiency anemia in those patients, and we recommend to Diagnose H.pylori gastritis and measure both serum and gastric juice Ascorbic acid in patients with refractory iron deficiency anemia and give emperical H.pylori eradicative therapy to patients with unexplained refractory IDA.