The affect of helicobacter pylori infection on hepcidin and il-6 levels; relationship with iron metabolism and hepcidin

Anemia consists one of the important extra gastric manifestations seen in Helicobacter pylori infections. In this group of patients, anemia presents without the signs of gastrointestinal bleeding or malabsorption and is resistant to iron therapy. This condition can occassionally be treated by the sole eradication of H. pylori. The aim of this study is to investigate the role of hepcidin in the development of anemia seen in H. pylori infections. Hepcidin is a fairly new discovered peptide hormone and is bound to ferroportin which is found in basolateral regions of enterocytes, macrophages and hepatocytes. In this way hepcidin inhibits the transportation of iron. In our study we set forward that the inflammation caused by H. pylori infection increases the synthesis of IL-6, thus enhances hepatic hepcidin synthesis which leads to hypoferremia and anemia.Patients aged between 7-16 years with complaints of recurrent stomachache and dyspepsia that underwent upper endoscopic investigation in pediatric gastroenterology clinic were planned to be enrolled in this study. After endoscopic investigation, patients of group 1 with manifested H. pylori infection will be checked for complete blood count, serum iron levels, iron binding capacity, ferritin levels, hepcidin, and IL-6 values prior to the initiation of proton pump inhibitors combined with antibiotherapy which will last for 8 weeks and this will be followed by the C-13 breath urea test for evaluation of eradication and the initial tests will be re-performed. Patients of group 2 with H. pylori negative gastritis will only receive proton pump inhibitors. This group will just undergo the tests used for diagnosis which are mentioned above. Group 1 and 2 will consist of 50 patients and the control group will consist of 30 healthy individuals.In our study, the mean age of patients with H. pylori positive gastritis were significantly higher; but there was no statistically significant difference with the gender of patients. The initial levels of ferritin, hepcidin and IL-6 were found significantly lower in patients with H. pylori induced gastritis. However parameters of complete blood count were similar between the groups H. pylori positive gastritis, H. pylori negative gastritis and healthy inviduals. In this study group; anemia was present in six patients of H. pylori positive gastritis and five patients of H. pylori negative gastritis. The mean levels of hepcidin, ferritin, IL-6 were significantly lower in patients with H. pylori infection regardless of the presence of anemia. In patients with H. pylori positive gastritis and anemia; the mean levels of Hb, Htc, MCV, MCH were significantly low. In this group related to the iron deficiency anemia, serum concentration of iron and ferritin were found lower; and iron binding capacity was found significantly higher.The results of this study did not support our hypothesis that H. pylori infection increases hepcidin levels. Our findings suggest that serum hepcidin levels are related to the status of iron deficiency anemia, rather than to the presence of H. pylori infection. After eradication Hb, Htc, MCV levels increased significantly, but the levels of hepcidin, ferritin and IL-6 didn?t differ significantly. All of the results support the expected fall of hepcidin levels in iron deficiency anemia.Key Words: Helicobacter pylori infection, Iron deficiency anemia, Hepcidin.