Helicobacter pylori-related peptic ulcer presenting as isolated iron deficiency anemia without typical gastrointestinal complaints in a child: a case report

Iron deficiency anemia (IDA) is the most common form of nutritional anemia in children worldwide. Helicobacter pylori (H. pylori) infection is a well-recognized contributor to pediatric IDA, through mechanisms including bleeding from peptic ulcers or erosions and impaired iron absorption, but it remains underappreciated in clinical practice, particularly in regions with high prevalence. Case description: We present the case of a 12-year-old boy with insidious-onset pallor, exertional fatigue, marked microcytic hypochromic anemia, and biochemical evidence of iron deficiency in the absence of dietary inadequacy or hereditary anemia. Notably, the lack of typical gastrointestinal (GI) symptoms delayed consideration of underlying GI pathology. Targeted investigations revealed H. pylori infection detected by the 13 C-urea breath test, and endoscopic findings of duodenal and gastric ulcers with H. pylori -associated gastritis, indicating chronic occult GI blood loss as the etiology. Conclusions: This case highlights that children with refractory iron deficiency anemia who lack typical abdominal discomfort symptoms, in addition to ruling out other common causes, the possibility of H. pylori infection causing peptic ulcers should be considered. Timely improve relevant examinations to detect and intervene in the causes of reversible anemia in children at an early stage.