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Iron deficiency anaemia can be improved after eradication of Helicobacter pylori
  1. Xiaolu Huang1,2,
  2. Xinhua Qu1,2,
  3. Weili Yan2,3,
  4. Youliang Huang4,
  5. Mingci Cai2,
  6. Bing Hu2,
  7. Lianming Wu2,
  8. Hai Lin5,
  9. Zhiwei Chen2,
  10. Cuiying Zhu2,3,
  11. Lungen Lu2,6,
  12. Xu Sun7,8,
  13. Lan Rong7,8,
  14. Yibin Jiang7,8,
  15. Dayu Sun7,8,
  16. Liang Zhong7,8,
  17. Ping Xiong1
  1. 1Shanghai No.9 People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
  2. 2Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
  3. 3Institute of Clinical Nuclear Medicine, Shanghai Jiaotong University School of Medicine, Shanghai, China
  4. 4Department of Cellular and Integrative Physiology, Indiana University School of Medicine, Indianapolis, Indiana, USA
  5. 5Shanghai Health Development Research Center, Shanghai, China
  6. 6Shanghai Institute of Digestive Diseases, Shanghai, China
  7. 7Department of Gastroenterology, Huashan Hospital affiliated to Fudan University, Shanghai, China
  8. 8Evidence-based Medicine Center of Fudan University, Shanghai, China
  1. Correspondence to Dr P Xiong, Department of Ultrasonic, Shanghai No.9 People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200011, China; pxiong6{at}


Background Recent guidelines on iron deficiency anaemia (IDA) have confirmed the aetiological role of Helicobacter pylori (H pylori), but the relationship still remains controversial.

Methods Starting in May 2009, searches of the following databases were undertaken: Medline (1966 to April 2009), Embase (1980 to April 2009), the Cochrane library (1800 to June 2008), Cochrane Central Register of Controlled Trials, Premedline, Healthstar, CBMdisc and the Chinese National Knowledge Infrastructure Database (January 1970 to April 2009). Changes in haemoglobin (Hb) concentrations and serum ferritin (SF) concentrations were recorded for intervention and control groups. The meta-analysis used random effect models and subgroup analyses were performed to explain heterogeneity.

Results Eight studies met the inclusion criteria. All studies were performed in Asia, an area with a high incidence of IDA and H pylori. The pooled analysis of eight studies showed that H pylori eradication therapy can improve IDA, since changes in Hb and SF concentrations in the intervention groups were higher than in controls. The weighted mean difference (WMD) of Hb was 12.88 g/l (95% CI 6.03 to 19.74 g/l, p<0.00001); the WMD of SF was 10.05 μg/l (95% CI 5.48 to 14.63 μg/l, p<0.00001).

Conclusions H pylori eradication therapy combined with iron administration is more effective than iron administration alone for the treatment of IDA. Eradication therapy has different effects on adults and children. Bismuth based triple therapy has a better response in terms of increased Hb and SF concentrations than proton pump inhibitor (PPI) based triple therapy.

  • Iron deficiency
  • Helicobacter pylori
  • hemoglobin
  • serum ferritin
  • meta-analysis
  • bacteriology, gastroenterology
  • anaemia
  • nutritional support

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  • Xiaolu Huang, Xinhua Qu, Weili Yan, and Youliang Huang contributed equally to this work as first author.

  • Funding The article included in this analysis were sponsored by several foundations, National Natural Science Foundation of China, Grant No. 30770599; Foundation of China Postdoctoral Science Foundation, Grant No.2005038143; Foundation of Shanghai Municipal Education Commission, Grant No.09YZ82; Foundation of Shanghai Leading Academic Discipline Project, Grant No. S30203; Natural Science Foundation of Shanghai Jiaotong University School of Medicine, Grant No. 2008XJ024.

  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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