Anemia of chronic disease (ACD), complicated by various chronic inflammatory diseases, is the second most prevalent type of anemia after iron deficiency anemia in the world. ACD significantly reduces the life quality of patients with chronic diseases, and represents an independent poor prognostic factor in certain chronic diseases. A large body of studies has demonstrated that most of anemia is related to abnormal iron metabolism. In the past decade, hepcidin, as a key factor in regulating iron metabolism, has attracted enormous attention due to its important role in the pathogenesis of ACD. This article reviews the research progress on the role and underlying regulatory mechanisms of hepcidin in ACD. We also discuss the potential of hepcidin as an effective therapeutic target for ACD treatment, in order to provide a new maneuver for improving the quality of ACD patients' life.
Anemia ; Anemia, Iron-Deficiency/pathology* ; Chronic Disease ; Hepcidins ; Humans ; Iron/metabolism*

Occult bleeding of the gastrointestinal tract is a major cause of iron deficiency anemia. Even with endoscopic evaluation of the upper and the lower gastrointestinal tract in these patients, in 30~50% of the cases, the cause of bleeding still remains undiscovered. Wireless capsule endoscopy (WCE) is a novel method of evaluating the small bowel mucosa by using a small capsule equipped with a camera and transmission device. Complications of WCE include impaction within the gastrointestinal tract, sometimes requiring surgical removal. The authors report a case of capsule impaction in the small bowel in a patient evaluated for anemia due to occult gastrointestinal tract bleeding. The patient is a 19 year-old female with a history of anemia since age 4. The stool guaiac test was positive, but upper and lower gastrointestinal tract endoscopy showed no abnormalities, so WCE was done. A short segment of circular ulcers with lumen narrowing were seen in the distal jejunum. Seven days after ingestion of the capsule, the patient denied passage of the capsule. Small bowel enteroclysis was performed, and the capsule was seen along with a segment of lumen narrowing distal to the site of retention. Surgery was done, and upon laparoscopic examination, the entire bowel appeared normal. Retrieval of the capsule was done along with a resection of an 8 cm segment of the small bowel. Three linear ulcers were seen in the resected bowel specimen. Pathology revealed no evidence of Crohn's disease or tuberculosis. The patient is still on iron supplements, but her hemoglobin level remains stable at 11~12 g/dl.
Anemia ; Anemia, Iron-Deficiency ; Capsule Endoscopy* ; Crohn Disease ; Eating ; Endoscopy ; Female ; Gastrointestinal Tract ; Guaiac ; Hemorrhage ; Humans ; Iron ; Jejunum ; Lower Gastrointestinal Tract ; Mucous Membrane ; Pathology ; Tuberculosis ; Ulcer ; Young Adult

This study assessed the prevalence of, and risk factors for, iron deficiency (ID) and iron deficiency anemia (IDA) among participants of the fifth Korean Health and Nutrition Examination Survey, 2010. Of 8,958 participants, 6,758 individuals > or =10 yr had sufficient data for the analysis of anemia and iron status. ID was defined as a transferrin saturation <10% or serum ferritin <15 microg/L. The prevalence of ID and IDA was 2.0% (95% confidence interval [CI], 1.3%-2.6%) and 0.7% (95% CI, 0.3%-1.0%), respectively, in males, and 22.4% (95% CI, 20.7%-24.2%) and 8.0% (95% CI, 6.8%-9.2%), respectively, in females. In reproductive age females, the prevalence of ID and IDA was 31.4% (95% CI, 28.9%-33.8%) and 11.5% (95% CI, 9.6%-13.4%), respectively. Compared to the prevalence of IDA in adult males 18-49 yr, the relative risks of IDA in adults > or =65 yr, lactating females, premenopausal females, and pregnant females were 8.1, 35.7, 42.8, and 95.5, respectively. Low income, underweight, iron- or vitamin C-poor diets were also associated with IDA. For populations with defined risk factors in terms of age, gender, physiological state and socioeconomic and nutritional status, national health policy to reduce IDA is needed.
Adolescent ; Adult ; Aged ; Anemia, Iron-Deficiency/*epidemiology/pathology ; Child ; Female ; Ferritins/blood ; Food Habits ; Humans ; Lactation ; Male ; Menopause ; Middle Aged ; *Nutrition Surveys ; Pregnancy ; Prevalence ; Republic of Korea ; Risk Factors ; Socioeconomic Factors ; Thinness ; Transferrins/analysis ; Young Adult

OBJECTIVETo study the alteration and significance of IL-6, vascular endothelial growth factor (VEGF), insulin-like growth factor-1 (IGF-1) in MM progression and the interaction between the three cytokines.

METHODSBone marrow samples from 28 patients with multiple myeloma (MM) (evolution group and steady group), 10 iron deficiency anemia (as normal control) and 2 monoclonal gammopathy of undetermined significance (MGUS) were studied. Bone marrow stromal cells (BMSCs) were established from the bone marrow MNCs. ELISA was performed to detect the concentration of IL-6, VEGF, IGF-1 in culture supernates.

RESULTS(1) The levels of IL-6 and VEGF secreted by BMSCs were increased in an order from normal control to steady group to evolution group (P < 0.05). However, the concentration of IGF-1 did not increase in MM patients (P > 0.05). (2) The levels of IL-6, VEGF and IGF-1 in the coculture supernates of U266 and BMSCs were increased significantly (P < 0.05), being in an ascending order from normal control to steady group to evolution group (P < 0.05). (3) BMSCs stimulated by exogenous IL-6, VEGF or IGF-1, secreted more VEGF, IGF-1/IL-6, IGF-1/VEGF, IL-6 than unstimulated (P < 0.05). (4) The levels of IL-6, VEGF, IGF-1 secreted by BMSCs from MGUS were similar to that from control group.

CONCLUSIONSIL-6, VEGF, IGF-1 levels associate with evolution of MM; IL-6, VEGF and IGF-1 induce an increase in cytokines secretion of BMSCs.

Anemia, Iron-Deficiency ; blood ; pathology ; Bone Marrow Cells ; metabolism ; pathology ; Cells, Cultured ; Female ; Humans ; Insulin-Like Growth Factor I ; metabolism ; Interleukin-6 ; blood ; Male ; Middle Aged ; Multiple Myeloma ; blood ; pathology ; Paraproteinemias ; blood ; pathology ; Stromal Cells ; metabolism ; pathology ; Vascular Endothelial Growth Factor A ; blood

BACKGROUND/AIMS: Helicobacter pylori (H. pylori) infection appears to subvert the human iron regulatory mechanism and thus upregulates hepcidin, resulting in unexplained iron-deficiency anemia (IDA). We evaluated serum prohepcidin levels before and after eradication of H. pylori in IDA patients to assess whether it plays a role in IDA related to H. pylori infection. METHODS: Subjects diagnosed with unexplained IDA underwent upper gastrointestinal endoscopy and colonoscopy to confirm H. pylori infection and to exclude gastrointestinal bleeding. Blood was sampled before treatment to eradicate H. pylori and again 1 month later. Serum prohepcidin levels were measured using a commercial enzyme-linked immunosorbent assay kit. RESULTS: Serum prohepcidin levels decreased significantly after oral iron replacement combined with H. pylori eradication (p = 0.011). The reduction ratio of serum prohepcidin levels after the treatment did not differ among the combined oral iron replacement and H. pylori eradication groups, the H. pylori eradication only group, and the iron replacement only group (p = 0.894). CONCLUSIONS: Serum prohepcidin levels decrease after both H. pylori eradication and oral iron administration, with improvement in IDA. Serum concentration of prohepcidin is related to the anemia status, rather than to the current status of H. pylori infection, in IDA patients.
Administration, Oral ; Adult ; Aged ; Anemia, Iron-Deficiency/*blood/drug therapy/*microbiology ; Antimicrobial Cationic Peptides/*blood ; Endoscopy, Gastrointestinal ; Female ; Follow-Up Studies ; Helicobacter Infections/*blood/*complications/pathology ; *Helicobacter pylori ; Humans ; Iron/administration & dosage ; Male ; Middle Aged ; Prospective Studies ; Protein Precursors/*blood ; Severity of Illness Index

OBJECTIVEDouble-balloon enteroscopy is a new method that allows complete visualization of the lumen of small bowel. This study was conducted to evaluate safety, extent of observation and clinical efficacy of double-balloon push enteroscopy in diagnosis of patients with small bowel disease in children.

METHODSFourteen cases suspected of small bowel diseases with negative findings on examinations with various routine diagnostic modalities underwent double-balloon push enteroscopy from June, 2003 to May, 2005. Of the 14 cases, 13 had gastrointestinal bleeding and iron deficient anemia and 1 case had chronic diarrhea, the causes of these conditions were unknown.

RESULTSThe enteroscopy reached jejunal-ileum transitional area, middle or lower portion of ileum and terminal ileum in 2, 10 and 2 cases, and the examination time was 40-50 min, 55-70 min and 78-89 min, respectively. Lesions were detected in 12 of 14 the cases. The positive diagnostic rate was 85.7%. There were no relevant technical problems or severe complications.

CONCLUSIONDouble-balloon push enteroscopy is a safe, reliable diagnostic modality of high clinical value for small bowel diseases in children.

Adolescent ; Anemia, Iron-Deficiency ; diagnosis ; etiology ; Catheterization ; instrumentation ; methods ; Child ; Child, Preschool ; Diagnosis, Differential ; Diarrhea ; etiology ; Endoscopes, Gastrointestinal ; adverse effects ; Endoscopy, Gastrointestinal ; adverse effects ; methods ; Female ; Gastrointestinal Hemorrhage ; diagnosis ; etiology ; Humans ; Intestinal Diseases ; complications ; diagnosis ; etiology ; pathology ; Intestine, Small ; pathology ; Male