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Copyright ©2014 Baishideng Publishing Group Co.
World J Gastroenterol. Feb 14, 2014; 20(6): 1379-1401
Published online Feb 14, 2014. doi: 10.3748/wjg.v20.i6.1379
Table 1 Association between Helicobacter pylori and iron stores in children: clinical and intervention studies
Study and study designStudy populationH. pyloridetectionInterventionOutcome: evaluationOutcome: results
Choe et al[18] 1999, South Korea; Randomized double-blind, placebo-controlled trial22 children with IDA and H. pylori infectionEGDSGroup A (n = 8): 2-wk triple eradication therapy and 10-wk oral ferrous sulfate; Group B (n = 5): 2-wk triple eradication therapy and10-wk placebo iron; Group C (n = 7): 2-wk placebo eradication therapy and 10-wk oral ferrous sulfateFollow-up of 18 children (group A, n = 6; group B, n = 5; group C, n = 7): changes in iron, Hb, SF, TIBC at 4 and 8 wk after the end of eradication therapyAt 8 wk, Hb significantly increased in all groups. No significant changes in iron, TIBC and SF occurred in any group
Choe et al[56] 2000, South Korea; Open therapeutic trial13 adolescents with sideropenic refractory anemia and H. pylori antral gastritisEGDSAll 13 children received 2-wk triple eradication therapy and 6-wk oral ferrous sulfateFollow-up of 11 adolescents: changes in Hb and SF 4 wk after the end of eradication therapyAt 4 wk Hb and SF significantly increased
Choe et al[17] 2001, South Korea; Open therapeutic trial21 adolescent athletes with IDA and H. pylori infectionEGDS12 received 2-wk triple eradication therapy; 9 received 10-wk oral ferrous sulfateFollow-up of 21 adolescents: changes in iron, Hb, SF, TIBC 10 wk after the start of either therapyHb, iron, SF increased significantly only in the athletes who received eradication therapy
Kurekci et al[62] 2005, Turkey; Clinical trial140 H. pylori-infected childrenSAT,14C UBTAll 140 children (18 with IDA, 36 with ID, 86 controls) received 2-wk triple eradication therapyFollow-up of 140 children: changes in Hb,SF, and MCV 4 wk after completion of eradication therapySF significantly increased in all groups; Hb and MCV values significantly increased only in IDA group
Mahalanabis et al[63] 2005, India; Randomized double-blind, placebo-controlled trial169 asymptomatic children: 85 H. pylori–positive, 84 H. pylori -negative13C UBT86 (42 H. pylori-positive, 44 H. pylori–negative) received 8-wk ferrous fumarate; 83 (43 H. pylori-positive, 40 H. pylori–negative) received 8-wk placeboFollow-up of 84 iron supplemented (42 H. pylori -positive and 42–negative) and 83 placebo children (43 H. pylori-positive and 40 –negative): changes in Hb, Ht, and SF after 8 wk of iron supplementation or placeboIn iron-supplemented group, SF improved in both H. pylori-positive and –negative children, while Hb and Ht significantly increased only in those H.pylori-negative; In the placebo group, no significant changes in Hb, Ht, and SF occurred regardless of H. pylori status
Gessner et al[67] 2006, Alaska; Randomized controlled household open trial219 children with ID and H. pylori infection13C UBT106 (intervention group) received 2-wk triple eradication therapy and 6-wk iron sulfate; 113 (control group) received 6-wk iron sulfateIn intervention group, 104, 94 and 94 children were, respectively, assessed 2, 8 and 14 mo after treatment initiation for ID and anemia; In control group, 110, 109 and 107 children were, respectively, assessed 2, 8 and 14 mo after completion of iron supplementation for ID and anemiaAt 14 mo, 65% and 72% of children in the intervention and control groups had, respectively, ID [AAR, 0.90 (95% CI,0.74-1.1)]; and 22% and 14% of children in the intervention and control groups had, respectively, anemia [AAR, 1.6 (95% CI, 0.86-2.9)].Results were similar when children were compared by H. pylori infection status
Sarker et al[66] 2008, Bangladesh; Randomized double-blind, placebo controlled trial200 asymptomatic children with H. pylori infection and IDA (n = 141) or ID (n = 59); 60 uninfected children with IDA (n = 49) or ID (n = 11)13C UBTRegimen 1 (n = 50): 2-wk triple eradication therapy and 90-d ferrous sulfate; Regimen 2 (n = 50): 2-wk triple eradication therapy and 90-d placebo iron; Regimen 3 (n = 49): 2-wk placebo eradication therapy and 90-d ferrous sulfate;Regimen 4 (n = 51): 2-wk placebo eradication therapy and 90-d placebo iron; Uninfected controls: 90-d iron therapy aloneFollow-up of 190 infected (regimen 1, n = 47; regimen 2, n = 49; regimen 3, n = 45; regimen 4, n = 49) and 55 uninfected children: changes in Hb, SF and sTfR 3 mo after the initiation of therapyImprovements in Hb, SF and sTfR were significantly greater in children who received iron therapy (regimens 1 and 3; negative control group) compared with the 2 other groups who did not receive iron (regimens 2 and 4);No differences in Hb, SF and sTfR values between children who remained positive and those who eradicated H. pylori
Fagan et al[68] 2009, Alaska; Randomized controlled household open trial219 children with ID and H. pylori infection13C UBT106 (intervention group) received 2-wk triple eradication therapy and 6-wk iron sulfate; 113 (control group) received 6-wk iron sulfateIn intervention group, 104, 94, 94 and 85 children were, respectively, assessed 2, 8,14 and 40 mo after treatment initiation for ID and anemia; In control group, 110, 109,107 and 91 children were, respectively, assessed 2, 8 ,14 and 40 mo after completion of iron supplementation for ID and anemiaControl and intervention groups had similar temporal trends regarding ID,anemia, and IDA.When groups were compared according to H. pylori infection status at 40 mo, children without H. pylori demonstrated better resolution of outcomes
Duque et al[65] 2010, Mexico; Randomized placebo- controlled trial69 children with ID/anemia: 33 H. pylori-infected in whom the organism was eradicated; 36 uninfected children13C UBTAfter completion of eradication, 17 received 12-wk ferrous sulfate, 16 children 12-wk placebo iron; Uninfected controls: 12-wk ferrous sulfateFollow-up of 33 H. pylori-infected children in whom the organism was eradicated, and 36 uninfected children: changes in Hb and SF after completion of the 12- wk regimenCompared to uninfected iron-supplemented controls, only children who eradicated H. pylori and received iron supplementation showed an increased Hb concentration. A significant SF increase occurred only in uninfected iron-supplemented controls compared to placebo group
Cardenas et al[44] 2011, Texas- United States; Randomized double-blind, placebo-controlled trial110 asymptomatic children with H. pylori-infectionIgG antibodies, 13C UBT32 received both quadruple sequential therapy and 6-wk iron supplementation; 29 quadruple eradication only; 23 iron supplementation only; 26 placebo onlyIntent-to-treat (n = 110) and per protocol (n = 90) analyses:changes in Hb,SF, and TrS at 8 mo from baselineIntent-to-treat and per-protocol analyses revealed no differences across study arms in changes of iron stores. However, children who eradicated the infection had a statistically significant larger increase in SF than children who remained infected
Xia et al[64] 2012, China; Randomized double-blind, controlled trial80 adolescents with IDA and H. pylori infectionIgG antibodies, SAT37 (intervention group) received 2-wk triple eradication therapy and 12-wk iron supplementation; 43 (control group) received 12-wk iron supplementation aloneFollow-up of 74 children: changes in Hb, SF, and sTfR 3 mo after completion of the 12-wk regimenHb and SF values were increased only in the intervention group. sTfR was significantly decreased in both the intervention and control groups
Table 2 Baseline clinical features of children with chronic idiopathic thrombocytopenic purpura
StudyNo. of patientsMale/femaleDisease durationConcomitanttherapy1Diagnosis ofH. pyloriinfectionNo. of infected childrenNo. of infected untreated childrenAge of infected children, yrAge of uninfectedchildren, yrPLT count (× 109/L) among treatedH. pylori-positive/No. of childrenPLT count (× 109/L) amongH. pylori-negative/No. of childrenPLT count (× 109/L) among untreatedH. pylori-positive/No. of children
Jaing et al[95] 2003, Taiwan2213/929 ± 26 mo13/22Stool antigen905 (1-13.5)8.7 (1.8-17.3)< 50/950-99/3 < 50/10-
Rajantie et al[96] 2003, Finland177/103.9 (0.6-14.5) yrNRH. pylori antibodies and/or 13C UBT003.82 (0.3-14.3)---
Hayashi et al[97] 2005, Japan106/44.2 ± 3.2 yrNRStool antigen and/or 13C UBT219 (7-11)9 (4-14)50-99/150-99/4 < 50/4< 50/1
Yetgin et al[98] 2005, Turkey35NR≥ 2 yrNRH. pylori antibodies and/or histology/13C UBT110NRNRNR< 50/11< 50/24-
Loffredo et al[99] 2007, Italy3913/26> 6 mo-H. pylori antibodies, 13C UBT, or stool antigen80112 (4.4-17)< 100/8< 100/31-
Neefjes et al[100] 2007, Netherlands4718/29> 1 yr-Stool antigen30 ≤ 162< 100/3< 100/44-
Wu et al[101] 2007, Taiwan3218/14NR32/32Stool antigen665.13 (1.9-9.8)4.13 (0.2-13.5)-8.8 ± 11.3/265.5 ± 4.7/6
Bisogno et al[102] 2008, Italy249/151.2 (0.6-24) yr-Stool antigen, 13C UBT8013.2 (4.6-25.1)12.52 (2-25.1)10.8 (2-16.5)< 50/850-99/3 < 50/13-
Hamidieh et al[103] 2008, Iran3114/172.3 ± 1.7 yrNR13C UBT408.923 (3.5-14)100/1 < 50/3NR-
Treepongkaruna et al[105] 2009, Thailand167/91.2-9.5 yr9/1613C UBT16497.4 -16.523 (3.0-84.0)/7-34 (3.0-86.0)/9
Ferrara et al 2009[104], Italy2414/101.8 (1.3-2.3) yr-Stool antigen807.5 (6.7-10.2)7.8 (5.4-10.7)29.8 ± 3.8/833.5 ± 3.8/16-
Russo et al 2011[106], Italy3712/25> 1 yr-Stool antigen374-12.3 ± 4.3513.6 ± 2.96--26.5 ± 22.3/33527.7 ± 22.3/46--
Table 3 Follow-up and platelet response to Helicobacter pylori eradication therapy among children with chronic idiopathic thrombocytopenic purpura
StudyFollow-upBacterialeradicationPLT count (× 109/L) among treatedH. pylori-positive with eradication success/No. of childrenPLT count (× 109/L) among treatedH. pylori-positive with eradication failure/No. of childrenPLT count (× 109/L) among untreatedH. pylori-positive/No. of childrenPLT count (× 109/L) amongH. pylori-negative/No. of children
Jaing et al[95] 2003, Taiwan6 mo9/9> 150/2--50-99/4
100-150/2< 50/9
50-99/1
< 50/4
Hayashi et al[97] 2005, Japan1 yr1/1> 150/1-NR> 100/2
NR/6
Yetgin et al[98] 2005, Turkey1 yr9/11< 50/9< 50/2-NR
Loffredo et al[99] 2007, Italy1 yr7/8NANA-< 100/31
Neefjes et al[100] 2007, Netherlands6-9 mo3/3≥ 100/3--51 ± 39.6/30
Wu et al[101] 2007, TaiwanNR---88.2 ± 89.5/6164.9 ± 75.8/161
132.7 ± 74.7/92
Bisogno et al[102] 2008, Italy6-50 mo8/8> 150/3--> 100/3
< 50/550-99/8
< 50/5
Hamidieh et al[103] 2008, Iran6-11 mo4/450-99/2--NR
< 50/2
Treepongkaruna et al[105] 2009, Thailand6 mo7/7> 100/1-> 100/1-
< 100/6< 100/7
Ferrara et al[104] 2009, Italy1 yr8/8≥ 150/6--50-99/7
100-149/2< 50/9
Russo et al[106] 2011, Italy1 yr33/37> 150/7< 50/4--
50-149/6
< 50/20