Prohepcidina y estado del hierro e inflamación en escolares sanos o H. pylori positivos asintomáticos / Prohepcidine iron status and inflammation in healthy and asymptomatic H. pylori school children / Pró-hepcidina estado de ferro e inflamação em estudantes saudáveis ou H. pylori positivos assintomáticos

El eje hepcidina-ferroportina es determinante en la homeostasis del hierro. Niveles elevados de hepcidina reducen la capacidad de absorción intestinal del hierro, así como su movilización entre tejidos. Una condición que produce valores séricos elevados de hepcidina es la infección. Como la infección con Helicobacter pylori (Hp) predispone a una deficiencia de hierro, en este estudio se evaluaron los niveles séricos de Pro-Hepcidina (PH), un precursor de la hepcidina, en un grupo de escolares asintomáticos, infectados con Hp (80 niños) y se los comparó con un grupo similar de niños sanos (59 niños). Los resultados mostraron que los niños infectados en los que se detectó la presencia de Hp (test de aire espirado) tenían valores de proteína C reactiva (PCR) significativamente más altos que los niños sanos. Ambos grupos presentaron valores similares de: adecuación de la ingesta de hierro, ferritina sérica (Fs), hemoglobina, hematocrito, receptores solubles de transferrina. La prevalencia de anemia y deficiencia subclínica de hierro en el grupo total (infectados + no infectados) fue de 10 y 60%, respectivamente sin diferencias entre los grupos. Sin embargo, en el grupo de niños sanos la PH sérica correlacionó significativamente (r=0,730/p<0,001) con los niveles de Fs, mientras que en los niños infectados, los niveles de PH no correlacionaron con la Fs, pero correlacionaron con la severidad de la infección (r=0,52/p<0,001). Esta tendencia de la PH a aumentar con la severidad de la infección podría explicar la mayor prevalencia de deficiencia de hierro en pacientes infectados con Hp.

The hepcidin-ferroportin axis is crucial in iron homeostasis. High serum hepcidine reduces iron intestinal absorption and tissue iron mobilization. Infection and inflammation increase serum hepcidin, predisposing to iron deficiency. Since Helicobacter pylori (Hp) infection has been associated to iron deficiency, the serum levels of prohepcidin PH (a precursor of hepcidin) were evaluated in 80 school children infected with Hp but without gastric symptoms. This was compared with PH levels in a group of 59 non Hp infected children. The results showed that infected children (exhaled air method) had higher levels of protein C reactive protein (CRP) than the non-infected group. Both groups had similar levels of iron consumption, serum ferritin (Fs), hemoglobin, hematocrit, soluble transferrin receptors and PH. The prevalence of anemia and of subclinical iron deficiency in the whole group (infected + non-infected) reached 10 and 60% respectively with no differences between groups. However, in the group of non-infected children, serum PH correlated (r=0.730/ p<0.001) with Fs levels whereas in the infected children, PH did not correlate with Fs but it correlated with the severity of the infection (r = 0.52/p<0.001). The tendency of PH to increase with the severity of infection could explain the higher prevalence of iron deficiency seen in Hp infection.

O eixo hepcidina-ferroportina é determinante na homeostase do ferro. Níveis elevados de hepcidina reduzem a capacidade de absorção intestinal do ferro, bem como sua mobilização entre tecidos. Uma condição que produz valores séricos elevados de hepcidina é a infecção. Como a infecção pelo Helicobacter pylori (Hp) predispõe a uma deficiência de ferro, neste estudo foram avaliados os níveis séricos de Pro-hepcidina (PH), um precursor da hepcidina em um grupo de estudantes assintomáticos infectados com Hp (80 crianças) e foram comparados com um grupo similar de crianças saudáveis (59 crianças). Os resultados mostraram que as crianças infectadas em que se detectou a presença de Hp (método de ar exalado) tinham valores de proteína C-reativa (PCR) significativamente mais elevada do que as crianças saudáveis. Ambos os grupos tiveram valores semelhantes de adequação da ingestão de ferro, ferritina sérica (Fs), hemoglobina, hematócrito, receptores solúveis de transferrina. A prevalência de anemia e deficiência subclínica de ferro no grupo total (infectados + não infectados) foi de 10 e 60%, respectivamente, sem diferenças entre os grupos. No entanto, no grupo de crianças saudáveis a PH sérica correlacionou significativamente (r=0,730/p<0,001) com os níveis de Fs, ao passo que em crianças infectadas, os níveis de PH não correlacionaram com a Fs, mas correlacionaram com a gravidade da infecção (r=0,52/p<0,001). Esta tendência da PH a aumentar com a gravidade da infecção poderia explicar a elevada prevalência de deficiência de ferro em pacientes infectados com Hp.

Decreasing trend of Helicobacter pylori infection in children with gastrointestinal symptoms from Buenos Aires, Argentina.

BACKGROUND: Helicobacter pylori infection is declining in developed and developing countries. The aim of this study was to retrospectively evaluate over an 8-year period the rate of H. pylori infection in children with gastrointestinal symptoms from Buenos Aires, Argentina. MATERIALS AND METHODS: We reviewed the records of children referred from 2002 to 2009 to the gastroenterology unit of the Children Hospital "Superiora Sor Maria Ludovica" for evaluation of upper gastrointestinal signs and symptoms in which the (13) C-urea breath test was performed to diagnose H. pylori infection and a sociodemographic questionnaire was obtained. RESULTS: Records of a total of 1030 children and adolescents with a mean age of 9.99 years were included in the analysis. We found an H. pylori prevalence of 41.2% (95% CI, 36.9-46.0%) for the triennium 2002-2004, dropping to 26.0% (95% CI, 20.7-31.8%) in the triennium 2007-2009. CONCLUSION: Our results showed a significant decrease in H. pylori infection rates from children referred for upper gastrointestinal symptoms evaluation from 2002 to 2009, following the H. pylori epidemiologic trend reported in other countries.

Helicobacter pylori and anemia: a community-based cross-sectional study among adults in Southern Brazil / Helicobacter pylori e anemia: um estudo transversal de base populacional entre adultos no Sul do Brasil

To investigate the association between Helicobacter pylori and anemia, a community-based cross-sectional study was conducted among 18-45 year old users of the 31 primary health care units in Pelotas, Southern Brazil. Interviews using a structured questionnaire were carried out in waiting rooms during two work shifts. Anemia (hemoglobin < 11g/dL among pregnant women, < 12g/dL among women and < 13g/dL among men) was diagnosed from capillary blood (HemoCue) and H. pylori by means of a 13C-UBT. Information on socio-demographic, behavioral and biological characteristics was collected. Logistic and linear regression analyses were carried out, taking into account aggregated primary health care units. A total of 1,117 respondents fulfilled the inclusion criteria (losses/refusals: 8.1 percent). Prevalence of anemia was 20.6 percent (18.2-23.2 percent) and of H. pylori, 70.7 percent (68.0-73.6 percent). After allowing for age, sex and skin color the odds ratio for anemia among those who were diagnosed H. pylori positive was 0.94 (0.70-1.27). After allowing for sex, skin color, family monthly income, age, and smoking, the reduction in hemoglobin among H. pylori positive respondents was 0.07g/dL (-0.24-0.11; p = 0.4). There is no association between H. pylori and anemia among adults attending primary health care units in Southern Brazil.

Helicobacter pylori tem sido apontado como causa de anemia. Para investigar essa associação, estudo transversal de base populacional foi realizado entre adultos (18-45 anos de idade), usuários das 31 unidades básicas de saúde (UBS), em Pelotas, Sul do Brasil. Entrevistas com questionários estruturados foram feitas nas salas de espera, em dois turnos de trabalho. Anemia (hemoglobina < 11g/dL entre gestantes, < 12g/dL entre mulheres adultas e < 13g/dL entre homens) foi diagnosticada em sangue capilar (HemoCue). H. pylori foi identificado por 13C-Urea Breath Test. Foram coletadas informações sócio-demográficas, comportamentais e biológicas. Análise por regressão logística e linear, levando em conta a agregação por UBS. Dos 1.117 elegíveis, foram perdidos ou recusaram-se participar 8,1 por cento. A prevalência de anemia foi 20,6 por cento (18,2-23,2 por cento) e H. pylori, 70,7 por cento (68,0-73,6 por cento). Após ajuste para idade, sexo e cor, a odds ratio para anemia entre H. pylori positivos foi 0,94 (0,70-1,27). Na análise ajustada para sexo, cor, renda familiar, idade e tabagismo, o nível de hemoglobina foi 0,07g/dL menor (-0,24-0,11; p = 0,4) entre H. pylori positivos. Não há associação entre H. pylori e anemia entre adultos usuários de UBS no Sul do Brasil.

Validade de instrumento epidemiológico para rastrear H. pylori entre pacientes dispépticos / Validez del instrumento epidemiológico para rastrear H. pylori entre pacientes dispépticos / Validity of an epidemiologic instrument for H. pylori screening among dyspeptic patients

OBJETIVO:Validar um escore epidemiológico para identificar dispépticos positivos para Helicobacter pylori. MÉTODOS: Estudo transversal realizado com 434 indivíduos entre 18 e 45 anos de idade, portadores de dispepsia não investigada, usuários de unidades básicas de saúde de Pelotas (RS), entre 2006 e 2007. Dispepsia foi diagnosticada conforme Roma-II. O padrão-ouro para presença de H. pylori foi o teste respiratório com 13C-uréia. Analisou-se a associação entre H. pylori e variáveis independentes por regressão logística. O escore foi construído a partir de odds ratios ajustadas. Foram calculadas a sensibilidade, especificidade e valores preditivos. RESULTADOS: Dentre os dispépticos, a prevalência de H. pylori foi 74 por cento (IC 95 por cento: 69;77,7) e esteve associada diretamente à idade e número de irmãos na infância e inversamente à escolaridade, sendo essas variáveis utilizadas na construção do escore. Os valores do escore variaram de 3-9. Escores entre 7, 8 e 9 apresentaram sensibilidade, respectivamente, de 36,6 por cento, 22,3 por cento e 11,1 por cento; e valores preditivos positivos 87,8 por cento, 90,9 por cento e 92,1 por cento. Sem a aplicação do escore, três de cada quatro dispépticos receberiam tratamento para H. pylori, com a aplicação, menor número de dispépticos seriam encaminhados para tratamento (um em cada três, seis e 11, respectivamente, com os pontos de corte entre 7 e 9), porém às custas de alta taxa de casos falso-negativos. CONCLUSÕES: O escore não foi válido para identificação seletiva de dispépticos candidatos a tratamento erradicador para H. pylori. Diferentemente do recomendado para países desenvolvidos, a alta prevalência de H. pylori torna a estratégia testar-e-tratar inapropriada para uso nos países em desenvolvimento.

Validity of an epidemiologic instrument for H. pylori screening among dyspeptic patients.

OBJECTIVE: To validate an epidemiological score for identifying dyspeptic patients at high risk of being H. pylori positive. METHODS: Cross-sectional study including 434 users of primary health care units in the city of Pelotas, Southern Brazil, aged 18-45 years, and with symptoms of non-investigated dyspepsia, between 2006 and 2007. Dyspepsia was diagnosed according to Roma-II. The gold standard for H. pylori infection was the (13)C-urea-breath-test. The association between presence of H. pylori and independent variables was assessed through Logistic Regression. The score was built based on adjusted odds ratios. Sensitivity, specificity, and predictive values of different cutoffs were calculated. RESULTS: Prevalence of H. pylori dyspeptic subjects was 74% (95% CI: 69;77.7). Prevalence was directly associated with age and number of siblings during childhood, and inversely associated with schooling; these variables were used in the construction of the score. The score ranged from 3 to 9 points. Scores 7, 8, and 9 had sensitivity of 36.6%, 22.3%, and 11.1%, and positive predictive values of 87.8%, 90.9%, and 92.1%, respectively. Without the score, 3 in every 4 dyspeptic patients would have received H. pylori erradication therapy. This proportion would have been lower with the score (one in three, six, and 11, for the cutoff points betwewen 7 and 9, respectively), albeit at the expense of a high rate of false-negatives. CONCLUSIONS: The score was not valid for selectively identifying dyspeptic individuals candidate to eradication therapy for H. pylori. Contrary to the recommendation in developed countries, the test-and-treat strategy seems inappropriate for use in developing settings due to the high prevalence of H. pylori infection.

Helicobacter pylori and anemia: a community-based cross-sectional study among adults in Southern Brazil.

To investigate the association between Helicobacter pylori and anemia, a community-based cross-sectional study was conducted among 18-45 year old users of the 31 primary health care units in Pelotas, Southern Brazil. Interviews using a structured questionnaire were carried out in waiting rooms during two work shifts. Anemia (hemoglobin < 11g/dL among pregnant women, < 12g/dL among women and < 13g/dL among men) was diagnosed from capillary blood (HemoCue) and H. pylori by means of a 13C-UBT. Information on socio-demographic, behavioral and biological characteristics was collected. Logistic and linear regression analyses were carried out, taking into account aggregated primary health care units. A total of 1,117 respondents fulfilled the inclusion criteria (losses/refusals: 8.1%). Prevalence of anemia was 20.6% (18.2-23.2%) and of H. pylori, 70.7% (68.0-73.6%). After allowing for age, sex and skin color the odds ratio for anemia among those who were diagnosed H. pylori positive was 0.94 (0.70-1.27). After allowing for sex, skin color, family monthly income, age, and smoking, the reduction in hemoglobin among H. pylori positive respondents was 0.07g/dL (-0.24-0.11; p = 0.4). There is no association between H. pylori and anemia among adults attending primary health care units in Southern Brazil.

Effect of a probiotic food as an adjuvant to triple therapy for eradication of Helicobacter pylori infection in children.

OBJECTIVE: Current recommendations for treatment of Helicobacter pylori infection include a proton pump inhibitor in combination with two antibiotics. We evaluated the potential activity of a probiotic food as an adjuvant to antibiotic triple therapy for eradication of H. pylori infection in children from Buenos Aires, Argentina. METHODS: Sixty-five children who tested positive for H. pylori, as diagnosed by (13)C-urea breath test and endoscopy, were included in this study. Patients were randomized to receive 1-wk triple therapy plus probiotic food (treated group) or milk placebo (control) that was administered for 3 mo. Probiotic food consisted of 250 mL of a commercial yogurt containing Bifidobacterium animalis and Lactobacillus casei (10(7) colony-forming units/mL). Post-treatment urea breath test controls were performed 1 and 3 mo after the end of triple therapy. RESULTS: We found no significant differences in H. pylori eradication rates (ERs) at 1 and 3 mo between the treated group (ER = 45.5% and 42.4%) and the control group (ER = 37.5% and 40.6%). Relative risks between groups were 0.87 (95% confidence interval 0.58-1.32, P = 0.345) in the first month and 0.97 (95% confidence interval 0.64-1.46, P = 0.542) in the third month. CONCLUSIONS: We could not demonstrate an adjuvant effect of the studied probiotic food to triple therapy in the eradication of H. pylori infection in children in Buenos Aires, Argentina. However, we found lower ERs than those reported for the same therapeutic scheme in developed countries, indicating that bacterial resistance and alternative therapeutic strategies should be studied.

[Causes and consequences of iron deficiency on human health]. / Causas y consecuencias de la deficiencia de hierro sobre la salud humana.

Anaemia and nutritional iron deficiency significantly affect the world population. In this article we discuss the main causes and consequences that this nutritional deficiency produces on human health.

Causas y consecuencias de la deficiencia de hierro sobre la salud humana / Causes and consequences of iron deficiency on human health

La anemia y la deficiencia nutricional de hierro afectan a gran parte de la población mundial. En este artículo se discute las principales causas y consecuencias que produce esta deficiencia nutricional sobre la salud humana