DOI: https://doi.org/10.53350/pjmhs20221611270 ORIGINAL ARTICLE 270 P J M H S Vol. 16, No. 11, November, 2022 Improvement in Refractory Iron Deficiency Anemia after Successful Eradication of H-Pylori ANIQ FAYYAZ 1 , ABID ALI 2 , RAFIA WAJID 3 , SALMAN JAVED 2 1 Department of Gastroenterology, Bahawal Victoria Hospital, Bahawalpur-Pakistan. 2 Department of Gastroenterology, Services Hospital, Lahore-Pakistan 3 Department of Heamatology, Test Zone Diagnostic Centre, Lahore-Pakistan Correspondence to Dr. Aniq Fayyaz; Email: aniqfayyaz@gmail.com Tel:+92-321-6810995 ABSTRACT Background: Helicobacter pylori has caused gastritis leading to bleeding and iron deficiency anemia. H-pylori eradication results in better response to oral iron treatment. Aim: To determine the frequency of improvement in refractory iron deficiency anemia after successful eradication of H-pylori. Study design: Descriptive, case series. Methodology: Patients (n=89) of refractory iron deficiency anemia, 15-55 years of either gender were included. After this taking relevant history, urea breath test was done for H-Pylori. After this, 10 days of PPI, bismuth, tetracycline and nitromidazole was given to the positive patients. Improvement in iron deficiency anemia was noted after 3 months of H-pylori eradication therapy. SPSS v.26 analyzed the data. Mean and standard deviation were calculated for age, duration of iron deficiency anemia and BMI. Stratification of improvement in refractory iron deficiency anemia was done with respect to age, gender and BMI. Post stratification Chi-Squire test was applied with P-value ≤0.05 was taken as significant. Results: Mean age was 35.90 ± 9.89 years. Improvement in refractory iron deficiency anemia after eradication of h pylori was found in 54 (60.67%) patients, whereas there was no improvement in 35 (39.33%) patients. Practical Implication: This study provided the local stats of the problem and helped the clinicians to design a protocol for eradication of H pylori in these particular patients thus improving refractory IDA. Conclusion: It was concluded that frequency of improvement in refractory iron deficiency anemia after eradication of H-pylori was very high. Keywords: H-Pylori, Eradication and Refractory Iron Deficiency Anemia. INTRODUCTION H-pylori is slowly growing but highly mobile gram negative bacterium 1 . It resides in the deeper mucus gel coating gastric mucosa and affects almost half of the world 2 . The complication associated with this infection include chronic stomach inflammation, duodenal ulcer, gastric cancer and orogastric malt lymphoma 3 . Clinical picture of patients having peptic ulcer disease is variable and usually present with pain (epigastric, post-prandial, nocturnal), anaemia, weight-loss due to reduced appetite caused by fear of pain and vomiting 4 . It usually affects middle and old age patients 5 . According to an estimate, almost 500,000 new cases/year of peptic ulcers are reported in US. Unfortunately, its prevalence (85.1%) due to H- pylori in Pakistan is high thus causing gastritis and ulcers 6 . Among humans spontaneous iron excretion is minimum and common cause of iron deficiency anemia (IDA) among them is nutritional deficiency followed by an abnormal blood loss 1 . However, literature review have suggested that IDA and H pylori infection are closely inter linked. 2 One study suggested that atrophic changes in the gastric body among H-pylori-positive IDA patients were significantly high while remaining patients had chronic superficial gastritis extending to the fundic mucosa 3 . There are different H-pylori eradication therapies nowadays. However, first-line therapy for H-pylori infection is a combination of proton pump inhibitors (omeprazole) plus two antibiotics (clarithromycin and amoxicillin) administered for 7–14 days. Metronidazole is as an alternative to amoxicillin 6,7 . Other treatment option is sequential therapy 8 . Literature review showed that triple therapy has a serious decline in its efficacy attributed by increased antibiotic resistance of H. pylori especially to clarithromycin 8-10 . Other reasons include serious side effects of this combination of drugs such as nausea, vomiting, headache, dizziness and yeast infection in women 11,12 . Due to this reason, it has been suggested extending the duration of treatment or using the four drug treatment such as sequential therapy will improve efficacy of drugs for H-pylori eradication. ----------------------------------------------------------------------------------------- Received on 24-06-2022 Accepted on 16-10-2022 One study reported that majority of patients enrolled had unexplained refractory IDA due to active H pylori infection 13 . This study provided the local stats of the problem and helped the clinicians to design a protocol for eradication of H pylori in these particular patients. The objective of the study was to determine the frequency of improvement in refractory iron deficiency anemia after successful eradication of H-pylori. METHODOLOGY Study design was descriptive, case series. Present study involved Gastroenterology Department, General Hospital, Lahore. Sample size was 89 and population was Patients having refractory iron deficiency anemia. Patients from 15-55 years of age with either gender were included. Non-probability, consecutive sampling was done. After getting permission from IRB and taking relevant history, urea breath test was done for H-Pylori. After this, 10 days of PPI, bismuth, tetracycline and nitromidazole was given to the positive patients. Improvement in iron deficiency anemia was noted after 3 months of H-pylori eradication therapy. Written informed consent was taken. Patients with h/o gastrointestinal hemorrhage, pregnant females, peptic ulcer disease, CLD and CRF were excluded. Statistical analysis: SPSS v.26 analyzed the data. Mean and standard deviation were calculated for age, duration of iron deficiency anemia and BMI. Frequency and percentage were calculated for gender and improvement in iron deficiency anemia. Stratification of improvement in refractory iron deficiency anemia was done with respect to age, gender and BMI. Post stratification Chi-Squire test was applied with P-value ≤0.05 was taken as significant. RESULTS Males were 63(70.79%) while 26(29.21%) were females. Other demographic parameters like age, BMI of enrolled subjects were shown in table-1. Data for improvement in refractory iron deficiency anemia was stratified for age, gender and BMI to see the modifier effect as shown in Table-2.