Pervasive Occult Gastrointestinal Bleeding in an Alaska Native Population With Prevalent Iron Deficiency
Role of Helicobacter pylori Gastritis
- Ray Yip, MD, MPH;
- Paul J. Limburg, MD;
- David A. Ahlquist, MD;
- Herschel A. Carpenter, MD;
- Alice O'Neill, MS, RD;
- Donn Kruse, MD;
- Sean Stitham, MD;
- Benjamin D. Gold, MD;
- Elaine W. Gunter, MT;
- Anne C. Looker, PhD;
- Alan J. Parkinson, PhD;
- Elizabeth D. Nobmann, MPH, RD;
- Kenneth M. Petersen, MD;
- Mark Ellefson;
- Samuel Schwartz, MD
- From the Division of Nutrition, National Center for Chronic Disease Prevention and Health Promotion (Dr Yip), the Division of Bacterial and Mycotic Disease, National Center for Infectious Disease (Dr Gold), and the Division of Environmental Health Laboratory Sciences, National Center for Environmental Health (Ms Gunter), Centers for Disease Control and Prevention (CDC), Atlanta, Ga; the Division of Gastroenterology, Department of Internal Medicine (Drs Limburg and Ahlquist), and the Department of Laboratory Medicine and Pathology (Dr Carpenter), Mayo Clinic, Rochester, Minn; the Yukon-Kuskokwim Health Corporation, Bethel, Alaska (Drs Kruse and Stitham and Ms O'Neill); the Department of Pediatrics, Emory University School of Medicine, Atlanta, Ga (Dr Gold); the Division of Health Examination Statistics, National Center for Health Statistics, CDC, Hyattsville, Md (Dr Looker); the Arctic In-; vestigations Program, National Center for Infectious Disease, CDC, Anchorage, Alaska (Drs Parkinson and Petersen); the Alaska Area Native Health Service, Indian Health Service, Anchorage (Dr Petersen and Ms Nobmann); Ellefson Analytical Inc, Lino Lakes, Minn (Mr Ellefson); and the Minneapolis Medical Research Foundation, Minneapolis, Minn (Dr Schwartz).
Abstract
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.
Footnotes
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This study was presented in part at the 1994 American Gastroenterological Association meeting in New Orleans, La, May 1994; the 1994 World Congresses of Gastroenterology, Los Angeles, Calif, October 1994; and the 1995 Swedish Society of Medicine Berzeliuos Symposium XXXI on Iron Nutrition in Health and Disease, Stockholm, September 1995.
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Reprints: David A. Ahlquist, MD, Division of Gastroenterology, Mayo Clinic, Rochester, MN 55905.
