The authors performed a meta-analysis of 16 randomized controlled trials (956 patients) on iron deficiency anemia in H. pylori infection, and found that hemoglobin (Hb) and ferritin levels at the end of treatment (7 2 weeks) were 40-50% higher in patients receiving oral iron plus standard triple anti-H. pylori therapy compared to those receiving oral iron alone.

However, this meta-analysis has several important limitations, such as the small sample sizes and the low quality of most included studies, the tests used for confirming H. pylori infection (see McColl KE, N Engl J Med 2010;362:1597-1604), the possibility of publication bias in favor of positive results, and the lack of studies involving patients from Africa or Europe. Thus, the results should be interpreted with caution.

Despite the above-mentioned limitations, this paper contains two potentially important messages: 1) the possibility of H. pylori infection should be always taken into account in patients with severe or refractory iron deficiency anemia, and 2) treatment of H. pylori infection could improve anemia and iron status, particularly in moderate or severe iron deficiency anemia in which Hb is lower than 9 g/dL.

– Manuel Muoz