Introduction
Iron deficiency anemia (IDA) is a condition in which blood lacks adequate healthy red blood cells. IDA is one of the most common types of nutritional anemia in the world and is considered a major public health problem in developing countries especially in Yemen [1,2]. Which results from long-term negative iron imbalance (shortage of iron in the patient's body). Usually, deficiency of iron goes unnoticed develops gradually, and does not have clinically apparent symptoms until the body becomes more deficient in iron and anemia worsens [3]. IDA can be prevented by providing proper knowledge on a healthful diet, an improved lifestyle, and providing well-balanced food (iron-rich). The world health organization WHO estimates about 2 billion people in the world are suffering from anemia, and that approximately 50% of all anemia cases are diagnosed as IDA [1]. The best indicator of IDA is FERRITIN, and low ferritin alone is diagnostic of iron deficiency anemia [4]. Unexplained iron deficiency anemia in patients with H. pylori-positive gastritis can demonstrate that H. pylori cure led to a prolonged remission of iron dependence and to the resolution of iron deficiency anemia [5].
Helicobacter pylori is a gram-negative microaerophilic spiral-shaped flagellated bacillus that colonizes the mucus layer of gastric epithelium and infects approximately one-half of the world population, making it one of the most common bacterial infections[6]. It affects serum hemoglobin and serum ferritin level and increases iron losses, Helicobacter pylori (H. pylori) has been considered a major cause of the development of peptic ulcer disease and gastric malignancy. Recent studies have shown that H. pylori can also cause other extra gastric diseases [7]. H. pylori appears to be linked to a hematological disorder such as idiopathic thrombocytopenic purpura, vitamin B12 deficiency, and unexplained iron deficiency anemia [6].
Recently several sero epidemiologic studies have suggested a link between iron deficiency anemia and H. pylori infection [8]. The overall prevalence of anemia among H.pylori infected participants 29.2% were anemic, of which 69.2% had mild anemia and 63.5% had normocytic normochromic anemia[9]. According to certain research, H.Pylori colonization of the stomach mucosa may hinder iron intake, increase iron loss, and possibly cause IDA[10]. Since H. pylori need iron to survive, it is one of the few microbes that can obtain it directly from hemoglobin's heme, which is present in human [9], meta-analyses showed that H. pylori eradication combined with iron administration was more effective than iron administration alone for the treatment of IDA, which recommends testing and treatment for H. pylori infection in patients with unexplained IDA, This indicates a clear link between iron deficiency anemia and H.pylori infection [8].
H. pylori affects individuals of different age groups, the elderly have a higher prevalence of H. pylori infection, (aged >60 years, it was 39.4%) and risk of developing atrophic gastritis, and stomach cancer as well, People often get H. pylori infection during childhood [11]. Risk factors for H. pylori infection are related to Living in crowded conditions, living without a reliable supply of clean water, living in a developing country, and Living with someone who has an H. pylori infection [11]. Malabsorption a dietary assessment should be made in all patients to ascertain their iron intake. gastric acid is required to release iron from food and helps to keep iron in the soluble ferrous state.
Hypochlorhydria in this patient or due to drugs such as proton pump Inhibitors may contribute to the lack of iron availability from the diet as may previous gastric surgery
[12].
The study aims to investigate the prevalence of iron deficiency anemia among H. Pylori patients in private hospitals in Al-Mukalla city and to measure the accossiated risk factor that may increase the probability of iron deficiency anemia cases. The study's importance emerges from the small number of studies in our country that have been conducted on iron profile in patients with Helicobacter pylori infection, especially in the Hadhramout governorate. This current study will estimate the iron profile and help to detect the IDA in patients with H. pylori infection.