Pervasive occult gastrointestinal bleeding in an Alaska native population with prevalent iron deficiency. Role of Helicobacter pylori gastritis
R. Yip, P. J. Limburg, D. A. Ahlquist, H. A. Carpenter, A. O'Neill, D. Kruse, S. Stitham, B. D. Gold, E. W. Gunter, A. C. Looker, A. J. Parkinson, E. D. Nobmann, K. M. Petersen, M. Ellefson and S. Schwartz
Division of Nutrition, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Ga, USA.
OBJECTIVE: To confirm prevalent iron deficiency among Yupik Eskimos living
in Alaska and to explore the frequency of and potential lesions accounting
for occult gastrointestinal bleeding. DESIGN: Descriptive survey. SETTING:
Rural Arctic community. SUBJECTS: A total of 140 adult volunteers from 3
villages in the Yukon-Kuskokwim Delta region of western Alaska. MAIN
OUTCOME MEASURES: Daily iron intake, hematologic and biochemical indexes of
iron status, fecal hemoglobin levels, stool parasites, and endoscopic
findings. RESULTS: While dietary iron intake by Yupiks was similar to that
of a reference population, iron deficiency prevalence was increased 13-fold
in Yupik men and 4-fold in Yupik women. Fecal hemoglobin levels were
elevated in 90% of subjects contrasted with only 4% of a reference group;
median levels were 5.9 and 0.5 mg of hemoglobin per gram of stool,
respectively. Among 70 Yupik subjects with elevated fecal hemoglobin levels
who had endoscopy performed, 68 (97%) had an abnormal gastric appearance
consisting of erythema, mucosal thickening, diffuse mucosal hemorrhages,
erosions, or ulcerations. Gastric biopsies revealed chronic active
gastritis with associated Helicobacter pylori in 68 (99%) of 69. No other
hemorrhagic gastrointestinal disease was detected. CONCLUSIONS: Based on
this study sample, occult gastrointestinal bleeding appears to be pervasive
in the Yupik population and likely underlies the prevalent iron deficiency.
An atypical hemorrhagic gastritis associated with H pylori infection is
present almost universally and may represent the bleeding source.
