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The complicated relation of iron homeostasis and helicobacter pylori infection in the pediatric population: a review article
Heshmat Shahi , Fatemeh Kiaee ,
Volume 83, Issue 6 (9-2025)
Abstract
Helicobacter pylori is one of the most common chronic bacterial infections worldwide, with acquisition often occurring in childhood. While its role in the pathology of gastroduodenal diseases in adults is well-established, its impact on the pediatric population presents a unique set of clinical and pathophysiological challenges. This comprehensive review examines the complex and bidirectional relationship between Helicobacter pylori infection and host iron metabolism in pediatric and infant populations. For this review, the PubMed database was utilized for studies published from April 1979 through December 2024. Studies based on English language were included using the MESH terms "Helicobacter pylori," "iron," and "ferritin." According to the inclusion criteria, studies related to H. pylori infection and iron condition in patients under 18 years old were selected. Articles such as review articles, case reports, letters to the editor, and animal or in vitro studies were excluded. The main aim of this study was to illuminate the critical role of iron as an essential micronutrient and factor for both the host and the pathogen, examining the multifaceted mechanisms involved in H. pylori-induced iron homeostasis disruption in children.
The findings indicate a multifaceted relationship: virulent Helicobacter pylori strains are significantly and inversely associated with true body iron stores, leading to Iron deficiency anemia (IDA). However, chronic inflammatory states can paradoxically elevate ferritin levels, masking underlying iron deficiency. Complex interaction between bacterial infection, host inflammatory responses, and iron deficiency is an important factor influencing both the severity of the damage caused by this bacterial infection and its chronicity in the pediatric population. Identification and comprehensive understanding of these complex mechanisms is of great importance for the effective management of iron deficiency anemia in children with H. pylori infection. Considering, increase in the incidence of H. pylori infection in childhood, it is essential that H. pylori infection be evaluation in children with unknown reasons IDA. Finally, screening methods for H. pylori infection in children is recommended, as this could improve long-term health outcomes.

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