Controlled, Household-Randomized, Open-Label Trial of the Effect of Treatment of Helicobacter pylori Infection on Iron Deficiency among Children in Rural Alaska: Results at 40 Months

Background. Helicobacter pylori infection treatment was found not to reduce the prevalence of iron deficiency or anemia among Alaska Native children at 14 months after treatment initiation. We hypothesized that 14 months was too early to resolve H. pylori-induced gastric damage. Consequently, we conducted a 40-month follow-up. Methods. We enrolled 219 children 7-11 years old who had H. pylori infection (as diagnosed by C-13-labeled urea breath test) and iron deficiency (serum ferritin level, < 22.47 pmol/L) in a controlled, household-randomized trial of the effect of treatment of H. pylori on iron deficiency and anemia (hemoglobin level, < 115 g/L). At 40 months, 176 children were evaluated. Results. Forty-four (52%) of 85 children in the intervention group and 53 (58%) of 91 in the control group had iron deficiency (adjusted relative risk [ARR], 0.92 [95% confidence interval {CI}, 0.68-1.26]), versus 4 (5%) and 17 (19%), respectively, with both iron deficiency and anemia (ARR, 0.25 [95% CI, 0.09-0.73]). Reinfection occurred among 33 (52%) of 64 children who had cleared their infection. H. pylori-negative children had lower prevalences of iron deficiency (ARR, 0.62 [95% CI, 0.38-1.01]) and iron deficiency and anemia (ARR, 0.22 [95% CI, 0.03-1.50]), compared with H. pylori-positive children. Conclusions. The resolution of H. pylori infection for > 14 months modestly reduced the prevalence of iron deficiency and substantially reduced the prevalence of iron deficiency and anemia. H. pylori likely plays a causal role in hematological outcomes for some children.