Iron Deficiency Anemia Is Associated With Gastric Intestinal Metaplasia in Patients With Helicobacter pylori Infection

Background and Aims: Despite acknowledgment of the relationship between iron deficiency anemia (IDA) and Helicobacter pylori, consensus is lacking on clinical practice implications. This study sought to examine the association of iron deficiency and anemia with the precancerous lesion gastric intestinal metaplasia (GIM) in a cohort of patients with active H pylori infection. Methods: This retrospective cohort was assembled from adult patients diagnosed with H pylori at endoscopy at Duke University between 2015 and 2019. Data were collected from pathology reports and electronic health records. The relationship between iron deficiency status and GIM prevalence among 422 H pylori–positive individuals was examined using age-adjusted logistic regression models to estimate odds ratios (ORs) and 95% confidence intervals (CIs), and stratified by diagnosis of H pylori before the diagnosis at study enrollment. Results: Of these 422 H pylori–positive patients, 48.6% had evidence of anemia and/or iron deficiency in the electronic health record. Compared to patients without anemia, those with IDA were more likely to have GIM (OR = 1.66; 95% CI, 1.02–2.69). Fifty-seven patients were previously positive for H pylori, treated, and remained positive for H pylori at the index endoscopy, of whom 40% had IDA. Among these patients, those with IDA had 4-fold increased odds of having GIM compared to patients without anemia (OR = 4.11; 95% CI, 1.10–15.32) Conclusion: In a cohort of H pylori–positive individuals at endoscopy, those with a history of IDA had greater odds of having GIM compared to patients without anemia. These results suggest the importance of close endoscopic evaluation and sampling of the gastric mucosa to evaluate for GIM in patients with IDA, and particularly those with a previous H pylori diagnosis.