The Role of Helicobacter pylori Infection in Iron Deficiency and B12 Deficiency Anemia
https://doi.org/10.22416/1382-4376-2026-36-2-104-112
Abstract
Aim: to review the current literature on the potential link between Helicobacter pylori (H. pylori) infection and iron deficiency and vitamin B12 deficiency anemia.
Key points. Published studies have shown that iron deficiency anemia of unknown cause may be due to H. pylori infection, especially in pediatric practice. This infection can lead to impaired iron absorption through various mechanisms. Eradicating H. pylori infection can contribute to restoring normal red blood cell parameters. Additionally, patients infected with H. pylori have lower blood levels of vitamin B12 compared to uninfected individuals. The mechanisms contributing to impaired vitamin B12 absorption in patients with H. pylori infection may be associated with the progression of multifocal atrophic gastritis, as well as the production of antibodies against parietal cells and intrinsic factor. Many national gastroenterology societies and consensus meetings recommend testing for H. pylori infection patients with iron deficiency anemia or B12 deficiency anemia of unknown origin and, if positive, eradicating it.
Conclusion. There is a positive association between H. pylori infection and the development of unexplained iron deficiency anemia. The relationship between H. pylori infection and vitamin B12 deficiency anemia has not been sufficiently studied and requires further research.
About the Authors
A. A. SheptulinRussian Federation
Arkadiy A. Sheptulin — Dr. Sci. (Med.), Professor of the De- partment of Internal Diseases Propedeutics, Gastroenterology and Hepatology, N.V. Sklyfosovsky Institute of Clinical Medicine
119991, Moscow, Pogodinskaya str., 1, build. 1.
S. S. Kardasheva
Russian Federation
Svetlana S. Kardasheva — Cand. Sci. (Med.), Associate Professor of the Department of Internal Diseases Propedeutics, Gastroenterology and Hepatology, N.V. Sklyfosovsky Institute of Clinical Medicine
119991, Moscow, Pogodinskaya str., 1, build. 1.
A. A. Kurbatova
Russian Federation
Anastasia A. Kurbatova — Cand. Sci. (Med.), Teaching Assistant of the Department of Internal Diseases Propedeutics, Gastroenterology and Hepatology, N.V. Sklyfosovsky Institute of Clinical Medicine
119991, Moscow, Pogodinskaya str., 1, build. 1.
N. A. Benuni
Russian Federation
Nona A. Benuni — Student
119991, Moscow, Trubetskaya str., 8, build. 2.
References
1. Malfertheiner P., Megraud F., Rokkas T., Gisbert J.P., Liou I.-M., Schulz C., et al.; European Helicobacter and Microbiota Study group. Management of Helicobacter pylori infection: The Maastricht VI/Florence consensus report. Gut. 2022:gutjnl-2022-327745. DOI: 10.1136/gutjnl-2022-327745
2. O’Connor H.J., Axon A.T., Dixon M.F. Campylobacter-like organisms unusual in type A (perniciousanaemia) gastritis. Lancet. 1984;2(8411):1091. DOI: 10.1016/s0140-6736(84)91523-x
3. Mwafy S.N., Afana W.M. Hematological parameters, serum iron and vitamin B12 levels in hospitalized Palestinian adult patients infected with Helicobacter pylo ri: A case-control study. Hematol Transfus Cell Ther. 2018;40(2):160–5. DOI: 10.1016/j.htct.2017.11.010
4. Rahman Y.A., Ahmed L.A., Hafez R.M.M., Ahmed R.M.M. Helicobacter pylori and its hemato logical effect. Egypt J Intern Med. 2019;31:332–42. DOI: 10.4103/ejim.ejim_103_18
5. Sarari A.S., Farraj M.A., Hamoudi W., Essawi T.A. Helicobacter pylori, a causative agent of vitamin B12 deficiency. J Infect Dev Ctries. 2008;2(5):346–9. DOI: 10.3855/jidc.194
6. Sağlam N.Ö., Civan H.A. Impact of chronic Helicobacter pylori infection on inflammatory markers and hematological parameters. Eur Rev Med Pharmacol Sci. 2023;27(3):969–79. DOI: 10.26355/eurrev_202302_31190
7. Ayesh M.H., Jadalah K., Awadi E.A., Alawneh K., Khassawneh B. Association between vitamin B12 level and anti-parietal cells and anti-intrinsic factor antibodies among adult Jordanian patients with Helicobacter pylori infection. Braz J Infect Dis. 2013;17(6):629–32. DOI: 10.1016/j.bjid.2013.01.009
8. Shuval-Sudai O., Granot E. An association between Helicobacter pylori infection and serum vitamin B12 levels in healthy adults. J Clin Gastroenterol. 2003;36(2):130–3. DOI: 10.1097/00004836-200302000-00008
9. Presotto F., Sabini B., Cecchetto A., Plebani M., De Laz- zari F., Pedini B., et al. Helicobacter pylori infection and gastric autoimmune diseases: Is there a link? Helicobacter. 2003;8(6):578–84. DOI: 10.1111/j.1523-5378.2003.00187.x
10. Afsar M.N.A., Jhinu Z.N., Bhuiyan M.A.I., Islam Z., Siddigua T.J. Helicobacter pylori infection and micronutrient deficiency in pregnant women: A systematic review and meta-analysis. BMJ Open Gastroenterol. 2020;7(1):e000490. DOI: 10.1136/bmjgast-2020-000490
11. Yula E., Koksal F. Autoimmune extraintestinal manifestations of Helicobacter pylori infection: A bundle of conflicts. J Immunol Clin Microbiol. 2016;1(1):22–30. DOI: 10.5455/jicm.10.20160627
12. Lahner E., Annibale B. Pernicious anemia: New insights from a gastroenterological point of view. World J Gastroenterol. 2009;15(41):5121–8. DOI: 10.3748/wjg.15.5121
13. Rodrigues-Castro K.J., Franceshi M., Noto A., Miraglia C., Nouvenne A., Leandro G., et al. Clinical manifestations of chronic atrophic gastritis. Acta Biomed. 2018;89(8-S):88–92. DOI: 10.23750/abm.v89i8-S.7921
14. Lahnеr E., Zagari R.M., Zullo A., Sabatino A.D., Meggio A., Cesaro P., et al. Chronic atrophic gastritis: Natural history, diagnosis and therapeutic management. A position paper by the Italian Society of Hospital Gastroenterologists and Digestive Endoscopists [AIGO], the Italian Society of Digestive Endoscopy [SIED], the Itaian Society of Gastroenterology [SIGE], and the Italian Society of Internal Medicine [SIMI]. Dig Liver Dis. 2019;51(12):1621–32. DOI: 10.1016/j.dld.2019.09.016
15. Desai H.G., Gupte P.A. Helicobacter pylori link to pernicious anaemia. J Assoc Physicians India. 2007:55:857–9.
16. Amedeu A., Bergman M.P., Appelmelk B.J., Azzuri A., Benagiano M., Tamburini C., et al. Molecular mimicry between Helicobacter pylori antigens and H+, K+-adenosinetriphosphatase in human gastric autoimmunity. J Exp Med. 2003;198(8):1147–56. DOI: 10.1084/jem.20030530
17. Ivashkin V.T., Maev I.V., Lapina T.L., Fedorov E. D., Sheptulin A.A., Trukhmanov A.S., et al. Clinical recommendations of Russian Gastroenterological Association and RENDO Endoscopic Society on diagnosis and treatment of gastritis and duodenitis. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2021;31(4):70–99. (In Russ.) DOI: 10.22416/1382-4376-2021-31-4-70-99
18. Lento M.V., Rugge M., Lahner E., Micelo E., Toh B.-H., Genta R.M., et al. Autoimmune gastritis. Nat Rev Dis Primers. 2020;6(1):56. DOI: 10.1038/s41572-020-0187-8
19. Rustgi S.D., Bijlani P., Shah S. Autoimmune gastritis, with or without pernicious anemia: Epidemiology, risk factors, and clinical management. Ther ap Adv Gastroenterol. 2021:14:17562848211038771. DOI: 10.1177/17562848211038771
20. Marino M.C.A., de Oliveiro C.A., Rocha A.M.C., Ro cha G.A., Clementino N.C.D., Antunes L.F., et al. Long term effect of Helicobacter pylori eradication on plasma homocysteine in elderly patients with cobalamin deficiency. Gut. 2007;56(4):469–74. DOI: 10.1136/gut.2006.095125
21. Kotera T., Nishimi Y., Kushima R., Haruma K. Regression of autoimmune gastritis after eradication of Helicobacter pylori. Case Rep Gastroenterol. 2023;17(1):34–40. DOI: 10.1159/000528388
22. Kaptan K., Beyan C., Ural A.U., Cetin T., Avcu F., Gülsen M., et al. Helicobacter pylori — is it a novel causative agent in Vitamin B12 deficiency? Arch Intern Med. 2000;160(9):1349–53. DOI: 10.1001/archinte.160.9.1349
23. Ali H., Shariq T., Naseeb F., Rahman A.S., Jamal Q., Siddiqui M. Prevalence of vitamin B12 deficiency among H. pylori-positive patients presenting with functional dyspepsia at a tertiary care hospital in Karachi. SN Compr Clin Med. 2025;7;366. DOI: 10.1007/s42399-025-02175-w
24. Cai X., Li X., Jin Y., Zhang M., Xu Y., Liang C., et al. Vitamins and Helicobacter pylori: An updated comprehensive meta-analysis and systematic review. Front Nutr. 2022;8:781333. DOI: 10.3389/fnut.2021.781333
25. Tsay F.-W., Hsu P.-J. H. pylori infection and extragastroduodenal diseases. J Biomed Sci. 2018;25(1):65. DOI: 10.1186/s12929-018-0469-6
26. Allakky A. Exploring the association of Helicobacter pylori with anti-intrinsic factor and anti-parietal cell anti bodies in pernicious anemia: A systematic review. Cureus. 2023;15(9):e45887. DOI: 10.7759/cureus.45887
27. Demir A.M., Ateş B.B., Hizal G., Yarman A., Tuna Kırsaçlıoğlu C., Oğuz A.S., et al. Autoimmune atrophic gastritis: The role of Helicobacter pylori infection in children. Helicobacter. 2020;25(5):e12716. DOI: 10.1111/hel.12716
28. Ihara T., Ihara N., Kushima R., Haruma K. Rapid progression of autoimmune gastritis after Helicobacter pylori eradication therapy. Intern Med. 2023;62(11):1603–9. DOI: 10.2169/internalmedicine.0533-22
29. Li M., Huang Y., Liang X., Li X., Lu H. The prevalence and associated factors of autoimmune gastritis: Singlecen ter, hospital-based prospective study in China. BMC Gastroenterol. 2025;26(1):12. DOI: 10.1186/s12876-025-04491-w
30. Shah S.C., Piazuelo M.B., Kuipers E.J., Li D. AGA clinical practice update on the diagnosis and management of atrophic gastritis: Expert review. Gastroenterology. 2021;161(4):1325–32. DOI: 10.1053/j.gastro.2021.06.078
31. Ivashkin V.T., Maev I.V., Lapina T.L., Trukhman ov A.S., Rumyantseva D.E., Storonova O.A., et al. Clinical recommendations of the Russian Gastroenterological Association for the diagnosis and treatment of autoimmune gastritis. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2025;35(6):115–36. (In Russ.) DOI: 10.22416/1382-4376-2025-35-6-115-136
32. Iron deficiency anemia. Guidelines of the National Hematology Society and the National Society of Pediatric Hematologists, Oncologists. Rubricator of the Ministry of Health of the Russian Federation. 2021. (In Russ.)
33. Herschko C., Camaschella C. How I treat unexplained refractory iron deficiency anemia. Blood. 2014;123(3):326–33. DOI: 10.1182/blood-2013-10-512624
34. Burns M., Muthupalani S., Ge Z., Wang T.C., Baktha vatchalu V., Cunningham C., et al. Helicobacter pylori infection induces anemia, depletes serum iron storage, and alters local iron-related and adult brain gene expression in male INS-GAS mice. PLoS One. 2015;10(11):e0142630. DOI: 10.1371/journal.pone.0142630
35. Nasif W.A., Ali A.S.E., Alamodi H.S., Alrefai A.A., Alzubedi A.A., Almasoudi H.S., et al. Impact of Helicobacter pylori on hematological parameters among Saudi population. Saudi Med J. 2021;42(6):643–8. DOI: 10.15537/smj.2021.42.6.20210103
36. Lee J.Y., Kim S.E., Park S.J., Park M.I., Moon W., Kim J.H., et al. Helicobacter pylori infection and iron deficiency in non-elderly adults participating in a health check up program. Korean J Intern Med. 2022;37(2):304–12. DOI: 10.3904/kjim.2020.433
37. Bille B.B.E., Mabeku L.B.K. Relationship between active Helicobacter pylori infection and anemia, iron deficiency, iron deficiency anemia: A cross-sectional study in a sub-Saharan setting. JGH Open. 2022;6(8):554–68. DOI: 10.1002/jgh3.12787
38. Al Mutawa O.A., Izhari M.A., Alharbi R.A., Sin di A.A.A., Algarni A.M., Alotaibi F., et al. Helicobacter pylori (H. pylori) infection-associated anemia in the Asir region, Saudi Arabia. Diagnostics (Basel). 2023;13(14):2404. DOI: 10.3390/diagnostics13142404
39. Qu X.-H., Huang X.-Lu, Xiong P., Zhu C.-Y., Huang Y.-L., Lu L.G., et al. Does Helicobacter pylori infection play a role in iron deficiency anemia? A meta-analysis. World J Gastroenterol. 2010;16(7):886–96. DOI: 10.3748/wjg.v16.i7.886
40. Saju J.M., Mandal N., Kham N., Shahid R., Naik S.S., Ramphall S., et al. Is Helicobacter pylori a reason for unexplained iron deficiency anemia: A systematic review. Cu reus. 2022;14(9):e29112. DOI: 10.7759/cureus.29112
41. Сhoe Y.H., Kim S.K., Son B.K., Lee D.H., Hong Y.C., Pai S.Y. Randomized placebo-controlled trial of Helicobacter pylori eradication for iron-deficiency anemia in preadolescent children and adolescents. Helicobacter. 1999;4(2):135–9. DOI: 10.1046/j.1523-5378.1999.98066.x
42. Queiroz D.M.M., Harris P.R., Sanderson I.R., Windle H.J., Walker M.M., Rocha A.M.C., et al. Iron status and Helicobacter pylori infection in symptomatic chil dren: An international multi-centered study. PLoS One. 2013;8(7):e68833. DOI: 10.1371/journal.pone.0068833
43. Gheibi Sh., Farrokh-Ealamlou H.R., Noroozi N., Pakniyat A. Refractory iron deficiency anemia and Helicobacter рylori infection in pediatrics: A review. Iran J Ped Hematol Oncol. 2015;5(1):50–64.
44. Wang Z., Tan W., Xiong H., Huang J., Wei H., Li M., et al. Impact of Helicobacter pylori infection on iron deficiency anemia in children: A systematic re view and meta-analysis with early intervention implications. Front Microbiol. 2025;16:1541011. DOI: 10.3389/fmicb.2025.1541011
45. Walle M., Tesfaye A., Agidew M.M., Semaw M., Mekuria S., Getu F. The association of Helicobacter pylori infection with the risk of anemia in children: Systematic review and meta-analysis. BMC Infect Dis. 2025;25(1):23. DOI: 10.1186/s12879-024-10427-8
46. Annibale B., Capurso G., Lahner E., Passi S., Ricci R., Maggio F., et al. Concomitant alterations in intragastric pH and ascorbic acid concentration in patients with Helicobacter pylori gastritis and associated iron deficiency anemia. Gut. 2003;52(4):496–501. DOI: 10.1136/gut.52.4.496
47. Patterson S., Emerson J., Brown H., Alagesan P., Labriola C., Zuzul R., et al. Iron deficiency anemia is as sociated with gastric intestinal metaplasia in patients with Helicobacter pylori infection. Gastro Hep Adv. 2025;5(3):100852. DOI: 10.1016/j.gastha.2025.100852
48. Lee H.T., Lee A.Y., Hong H., Seo J.Y. Endoscopic predictors of iron deficiency in Helicobacter pylori gastritis: A Kyoto classification-based study. Clin Endosc. 2026;59(1):79–88. DOI: 10.5946/ce.2025.175
49. Kato S., Gold B.D., Kato A. Helicobacter pylori-as sociated iron deficiency anemia in childhood and adolescence-pathogenesis and clinical management strategy. J Clin Med. 2022;11(24):7351. DOI: 10.3390/jcm11247351
50. Kato S., Osaki T., Ramiya S., Zhang X.-S., Blaser M.J. Helicobacter pylori sabA gene is associated with iron deficiency anemia in childhood and adolescence. PLoS One. 2017;12(8):e0184046. DOI: 10.1371/journal.pone.0184046
51. Pacifico L., Osborn J.F., Tromba V., Romaggioli S., Bascetta S., Chiesa C. Helicobacter pylori infection and extragastric disorders in children: A critical update. World J Gastroenterol. 2014;20(6):1379–401. DOI: 10.3748/wjg.v20.i6.1379
52. Mendoza E., Dugue X., Hernandes Franco J.I., Reyes Maldonado E., Moran S., Martinez G., et al. Association between active H. pylori infection and iron deficiency assessed by serum hepcidin levels in school-age children. Nutrients. 2019;11(9):2141. DOI: 10.3390/nu11092141
53. Nishigaki Y., Sato Y., Sato H., Iwafuchi M., Terai S. In fluence of Helicobacter pylori infection on hepcidin expression in the gastric mucosa. Kurume Med J. 2023;68(2):107 13. DOI: 10.2739/kurumemedj.MS682011
54. Blecker U., Renders F., Lanciers S., Vandenplas Y. Syn copes leading to the diagnosis of a Helicobacter pylori pos itive chronic active haemorrhagic gastritis. Eur J Pediatr. 1991;150:560–1. DOI: 10.1007/BF02072207
55. Gheibi Sh., Noroozi M., Hejazi S., Karamyyar M., Far rokh-Eslamlou H. Severe anemia and Helicobacter pylori infection in school age children; A case report. Iran J Ped Hematol Oncol. 2016;6(1):64–9.
56. El Demerdash D.M., Ibrahim H., Hassan D.M., Mousta fa H., Tawfik N.M. Helicobacter pylori associated to un explained or refractory iron deficiency anemia: An Egyp tian single-center experience. Hematol Transfus Cell Ther. 2018;40(3):219–25. DOI: 10.1016/j.htct.2018.02.001
57. Hudak L., Jaraisy A., Haj S., Muhsen K. An updated systematic review and meta-analysis on the association between Helicobacter pylori infection and iron deficiency anemia. Helicobacter. 2017;22(1):е12330. DOI: 10.1111/hel.12330
58. Xie C., Xu L.-Y., Yang Z., Lu N.-H. Helicobacter pylori infection in Mongolian gerbils does not initiate hematological diseases. World J Gastroenterol. 2014;20(34):12308 12. DOI: 10.3748/wjg.v20.i34.12308
59. Jamieson J.A., Weiler H.A., Kuhnlein H.V., Ege land G.M. Prevalence of unexplained anaemia in Inuit men and Inuit post-menopausal women in Northern Labrador: International Polar Year Inuit Health Survey. Can J Public Health. 2016;107(1):e81–7. DOI: 10.17269/cjph.107.5173
60. John S., Baltodano J.D., Mehta N., Mark K., Mur thy U. Unexplained iron deficiency anemia: Does Helicobacter pylori have a role to play? Gastroenterol Rep (Oxf). 2018;6(3):215–20. DOI: 10.1093/gastro/goy001
61. Tseng D.S., Li D., Cholleti S.V., Wei J.C., Jodes ty Y., Pham H.-V. Effect of Helicobacter pylori treatment on unexplained iron deficiency anemia. Perm J. 2019;23(18):195. DOI: 10.7812/TPP/18-195
62. Zahmatkeshan M., Karimi M., Geramizadeh B., Eslam inasab S., Esmailnejad A., Safarpour A.R. Association between Helicobacter pylori infection and iron deficiency anemia in school-aged Iranian children. Indian Pediatr. 2019;56(5):387–9.
63. Chey W.D., Leontiadis G.I., Howden C.W., Moss S.F. AСG clinical guideline: Treatment of Helicobacter pylori infection. Am J Gastroenterol. 2017;112(2):212–39. DOI: 10.1038/ajg.2016.563
64. Ivashkin V.T., Mayev I.V., Lapina T.L., Sheptulin A.A., Trukhmanov A.S., Baranskaya Y.K., et al. Diagnostics and treatment of Helicobacter pylori infection in adults: Clinical guidelines of the Russian gastroenterological association. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2018;28(1):55–70. (In Russ.) DOI: 10.22416/1382 4376-2018-28-1-55-70
Review
For citations:
Sheptulin A.A., Kardasheva S.S., Kurbatova A.A., Benuni N.A. The Role of Helicobacter pylori Infection in Iron Deficiency and B12 Deficiency Anemia. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2026;36(2):104-112. https://doi.org/10.22416/1382-4376-2026-36-2-104-112
JATS XML




























