Hematologic manifestations of Helicobacter pylori infection

Table 4 Paradigm changes in the management of hematologic diseases related to Helicobacter pylori infection and its medical and social impact

Disease	Accepted paradigm	New paradigm	Medical and social impact
Iron deficiency1	The management of ID is palliative and is based on iron supplementation[38], but it often does not treat the immediate cause of ID[41]	With the incorporation of ID in the international consensus and management guides on H. pylori infection as an indication to "seek and eradicate"[19-28], a new paradigm was generated. The etiology of ID can be infectious and eradication of H. pylori can be enough to "cure" in the strict sense of the word[52-56]	Under the new paradigm, eradication of the infection can correct ID, in addition to restoring health[52-56] and increase the productivity of the infected people[38]. It also reduces the prevalence of H. pylori infection and associated diseases such as gastric cancer[4], and peptic acid disease[3]
Vitamin B12 deficiency2	Vitamin B12 deficiency management is palliative and is based on the supplementation of vitamin[38], but often it does not treat the underlying cause of deficiency of vitamin B12[320]	With the incorporation of vitamin B12 deficiency in the international consensus and management guides on H. pylori infection as an indication to "seek and eradicate"[25,27] a new paradigm was generated. The etiology of vitamin B12 deficiency can be infectious, and the eradication of H. pylori can be enough to "correct" in the strict sense of the word[52-56,131]	Under the new paradigm, eradication of the infection can correct the vitamin B12 deficiency, and the patient can avoid palliative treatment[131] associated with chronic disease[38]. These include the closely related gastric cancer and diverse diseases such as Alzheimer's disease[108,109], dementia[110,111], depression[112], cerebral stroke[113,114] pulmonary embolism[115,116], acute myocardial infarction and coronary heart disease[117]. Additionally, it can prevent other manifestations of vitamin B12 deficiency and in the homocysteine pathway, which can generate high morbidity and mortality with elevated costs for health systems
Immune thrombocytopenia3	Treatment of immune thrombocytopenia is palliative, not curative. It is aimed to control the production of antibodies against platelets by medication or removal of organs that destroy platelets, such as the spleen[140,321]	With the incorporation of immune thrombocytopenia in the international consensus and management guides on H. pylori infection as an indication to "seek and eradicate"[19,21-28] a new paradigm was generated. The etiology of immune thrombocytopenia can be infectious and eradication of H. pylori can be enough to "cure" in the strict sense of word[154-192,204]	Under the new paradigm, where the eradication of the infection corrects the platelet count and is a definitive cure for immune thrombocytopenia, the patient avoids chronic disease[38] and non-curative and palliative treatment[131]. Moreover, eradication of infection in these patients reduces the prevalence of gastric cancer and peptic ulcer disease, which are closely related to high morbidity, mortality and high costs for health systems
Gastric MALT lymphoma	Gastric lymphoma is a manifestation of extranodal non-Hodgkin lymphoma. Treatment includes radical gastrectomy supplemented with total abdominal radiotherapy and chemotherapy, similar to the treatment that administered for other non-Hodgkin lymphomas[322]	With the incorporation of gastric MALT lymphoma in the international consensus and management guides on H. pylori infection as an indication to "investigate and eradicate"[19-37] a new paradigm was generated. The etiology of gastric MALT lymphoma can be infectious and eradication of H. pylori may be sufficient for "cure" in the strict sense of the word[220,261,262]	Under the new paradigm, whereby the eradication of the infection induced a complete remission with a definitive cure of gastric MALT lymphoma immune, the patient avoids a chronic disease[38], with non-curative and palliative treatment[322]. This change transforms a neoplastic disease with difficult and expensive management into an infectious disease with an excellent prognosis and low treatment cost[323]

¹With or without anemia;

²Cobalamine;

³Previously called idiopathic thrombocytopenic purpura and autoimmune thrombocytopenic purpura[138]. H. pylori: Helicobacter pylori; ITP: Immune thrombocytopenic purpura; MALT: Mucosa-associated lymphoid tissue.