Iron Pill-Induced Gastritis

Hashash, Jana G.; Proksell, Siobhan; Kuan, Shih–Fan; Behari, Jaideep

doi:10.14309/crj.2013.7

Cited by 20 publications

(17 citation statements)

References 2 publications

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“…The mucosal injury caused by iron resembles to that caused by a chemical burn, endoscopically presenting under the aspect of erosion, ulceration, or diffuse gastritis. [ 4 ] The histopathological exam will reveal the presence of brown deposits, mainly extracellular, luminal, lying adjacent to the surface epithelium or both. [ 3 ] Also, crystalline iron can be encountered at the level of lamina propria, granulation tissue, or in the blood vessels as iron-containing thrombi.…”

Section: Introductionmentioning

confidence: 99%

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A rare case of iron-pill induced gastritis in a female teenager

et al. 2017

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Rationale:The treatment of iron-deficiency anemia with oral iron supplements can present side-effects on the GI tract mucosa including necrosis, ulceration, or ischemia. The particular endoscopic findings and the histopathological exam will establish the diagnosis of erosive gastritis with iron deposits in the gastric mucosa.Patient concerns:We present the case of a 14-year-old female admitted in our clinic for upper digestive hemorrhage, nausea, melena, and abdominal pain. Her personal history revealed iron deficiency anemia receiving oral iron supplements for approximately 2 weeks.Diagnosis:The laboratory tests at the moment of admission pointed out anemia, increased level of serum iron, increased liver transaminases, a decreased level of ferritin, but with normal levels of both total iron-binding capacity and transferrin.Interventions:The eso-gastro-duodenoscopy revealed multiple brown deposits on the surface of the gastric mucosa and multiple hemorrhagic lesions, under the aspect of erosions all over the gastric mucosa, but more severe in the antral part, and the histopathological exam confirmed the presence of iron deposits at this level.Conclusion:Iron-pill induced gastritis is a rare, under-diagnosed entity that can be present even at pediatric ages with potential severe clinical impact.

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Section: Introductionmentioning

confidence: 99%

“…[ 3 , 5 ] This type of gastric injury is produced though a direct effect of iron on the gastric mucosa and it was suggested that its severity depends on the concentration of iron compound; therefore, this effect was not noticed in patients receiving a liquid form of iron supplement. [ 4 ]…”

Section: Introductionmentioning

confidence: 99%

A rare case of iron-pill induced gastritis in a female teenager

et al. 2017

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“…Therapeutic doses of oral iron are commonly employed for the treatment of iron deficiency anemia but can also cause local effects, primarily due to prolonged impaction of tablets in patients with underlying infectious, mechanical, toxic or systemic medical conditions. 1 , 4 , 6 , 14 , 18 Abraham et al 4 reported that the prevalence of therapeutic oral iron-associated erosive mucosal injury is 0.7% of all GI mucosal biopsies. It may occur within a few hours to days after iron tablet ingestion.…”

Section: Resultsmentioning

confidence: 99%

“… 8 The liquid iron does not have the same side effect as the solid iron of causing mucosal injury because it lacks the concentration effect necessary to cause damage. 18 Of the solid oral formulations, ferrous sulfate was the most damaging to the upper GI tract followed by ferrous gluconate, ferrous succinate, and finally, ferrous carbonate tablets. 4 , 6 There have been some cases described in which the iron is seen deposited without any visible erosions or ulcerations on the mucosa.…”

Section: Resultsmentioning

confidence: 99%

Gastric siderosis: An under-recognized and rare clinical entity

et al. 2016

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The increased deposition of iron in gastric mucosa is known as gastric siderosis. It is believed that the only regulated step of the iron metabolism cycle occurs during absorption in the small intestine. Once this system becomes overwhelmed due to either local or widespread iron levels, then iron can be absorbed very quickly by a passive concentration-dependent mechanism. This excess iron is initially stored in the liver but later can be found in the pancreas, heart and joints. Excess iron is not expected to deposit in the gastric mucosa. This gastric deposition has been found in association with hemochromatosis, oral iron medications, alcohol abuse, blood transfusions, hepatic cirrhosis and spontaneous portacaval shunt with esophageal varices. The precise mechanism of this iron deposition in gastric epithelial and stromal cells is still not well understood; thus, identification of iron in gastric mucosa raises many questions. On histology, the pattern of deposition is variable, and recognition of the pattern is often useful to choose the appropriate workup for the patient and to diagnose and possibly treat the cause of iron overload. In this article, we have described a well-referenced review of this rare clinical entity with different histological patterns, diagnostic tests and the clinical significance of the different patterns of iron deposition.

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“…Liquid preparations may minimise gastrointestinal upset and avoid the risk of iron tablet-induced gastric erosion. 45,46 Co-administration of oral iron with ascorbic acid is advocated by some experts because of the theoretical enhancement of iron absorption by reduction of ferric iron to the ferrous form. 47 Indeed, oral ascorbic acid administration was associated with a dose-dependent increase of oral iron absorption in healthy volunteers.…”

Section: Route and Dosing Of Iron Replacement Therapymentioning

confidence: 99%

Joint recommendations on management of anaemia in patients with gastrointestinal bleeding in Hong Kong

Mak¹,

Wallis

Hui

et al. 2018

Hong Kong Med J

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The demand for blood products continues to grow in an unsustainable manner in Hong Kong. While anaemia associated with gastrointestinal bleeding (GIB) is the leading indication for transfusion, there is no local recommendation regarding best practices for transfusion. We aimed to provide evidence-based recommendations regarding management of anaemia in patients with acute and chronic GIB. We reviewed all original papers, meta-analyses, systematic reviews, or guidelines that were available in PubMed. For acute GIB, a restrictive transfusion strategy, targeting a haemoglobin threshold of 7 to 8 g/dL, should be adopted because overtransfusion is associated with significantly higher all-cause mortality and re-bleeding. A liberal transfusion strategy should only be considered in patients with co-existing symptomatic coronary artery disease, targeting a haemoglobin threshold of 9 to 10 g/dL. When acute GIB settles, patients should be prescribed iron supplements if iron deficiency is present. For chronic GIB, iron stores should be replenished aggressively via iron supplementation before consideration of blood transfusion, except in patients with symptoms of severe anaemia. Oral iron replacement is the preferred first-line therapy, while intravenous iron is indicated for patients with inflammatory bowel disease, poor response or poor tolerability to oral iron, and in whom a rapid correction of iron deficit is preferred. Intravenous iron is underutilised and the risk of anaphylactic reaction to current preparations is extremely low. These recommendations are provided to local clinicians to facilitate judicious and appropriate use of red cell products and iron replacement therapy in patients with GIB.

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Iron Pill-Induced Gastritis

Cited by 20 publications

References 2 publications

A rare case of iron-pill induced gastritis in a female teenager

A rare case of iron-pill induced gastritis in a female teenager

Gastric siderosis: An under-recognized and rare clinical entity

Joint recommendations on management of anaemia in patients with gastrointestinal bleeding in Hong Kong

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