PERVASIVE OCCULT GASTROINTESTINAL-BLEEDING IN AN ALASKA NATIVE POPULATION WITH PREVALENT IRON-DEFICIENCY - ROLE OF HELICOBACTER-PYLORI GASTRITIS

Objective.-To confirm prevalent iron deficiency among Yupik Eskimos li ving in Alaska and to explore the frequency of and potential lesions a ccounting for occult gastrointestinal bleeding. Design.-Descriptive su rvey. Setting.-Rural Arctic community. Subjects.-A total of 140 adult volunteers from 3 villages in the Yukon-Kuskokwim Delta region of west ern Alaska. Main Outcome Measures.-Daily iron intake, hematologic and biochemical indexes of iron status, fecal hemoglobin levels, stool par asites, 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 wom en, Fecal hemoglobin levels were elevated in 90% of subjects contraste d 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 subject s with elevated fecal hemoglobin levels who had endoscopy performed, 6 8 (97%) had an abnormal gastric appearance consisting of erythema, muc osal thickening, diffuse mucosal hemorrhages, erosions, or ulcerations . Gastric biopsies revealed chronic active gastritis with associated H elicobacter pylori in 68 (99%) of 69. No other hemorrhagic gastrointes tinal disease was detected. Conclusions.-Based on this study sample, o ccult gastrointestinal bleeding appears to be pervasive in the Yupik p opulation and likely underlies the prevalent iron deficiency. An atypi cal hemorrhagic gastritis associated with H pylori infection is presen t almost universally and may represent the bleeding source.