Treatment of H. pylori-associated extragastric diseases

Besides H. pylori’s well-known roles in gastroduodenal diseases, some authors have proposed a link between H. pylori and a number of extragastric diseases involving the cardiovascular, pulmonary, hepatobiliary, hematologic, and other systems. Most of these reports are epidemiological or eradication trials. Idiopathic thrombocytopenic purpura and iron-deficiency anemia are the diseases that show the strongest link with H. pylori infection. According to American College of Gastroenterology Guideline on the Management of H. pylori Infection, unexplained iron-deficiency anemia belongs to controversial indications for diagnosis and treatment of H. pylori. Many cases relating H. pylori infection to iron-deficiency anemia have been described in the literature and H. pylori infection has emerged as a cause of refractory iron-deficiency anemia which is unresponsive to oral iron therapy. H. pylori-associated iron-deficiency anemia can be treated by H. pylori eradication. The mechanism by which H. pylori infection contributes to iron-deficiency anemia remains unclear. H. pylori-associated iron-deficiency anemia seems to develop in populations at increased risk for iron depletion. When pubescent girls, including athletes, are found to have iron-deficiency anemia refractory to iron administration, they should be evaluated for H. pylori infection. (Korean J Med 75:508-514, 2008)