Decreased Treatment Failure Rates following Duodenal Release Ferrous Glycine Sulfate in Iron Deficiency Anemia Associated with Autoimmune Gastritis and <i>Helicobacter pylori</i> Gastritis

Abstract

Background and Objectives: Since gastric acidity and ascorbate play a critical role in the solubilization and reduction of iron for subsequent absorption, the achlorhydria associated with autoimmune and Helicobacter pylori gastritis may explain the poor response of such patients to oral iron treatment. In order to circumvent this problem, we explored the therapeutic potential of a duodenal formulation of ferrous glycine sulfate consisting of micropellets that do not dissolve at the acid environment of the stomach but, owing to their solubility at a higher pH, discharge their content directly into the duodenum. Design and Methods: In a case-control study, the treatment results of 39 patients with iron deficiency anemia receiving a duodenal formulation of ferrous glycine sulfate (group A) were compared with the results of 39 patients receiving other oral iron compounds (group B). Autoimmune gastritis, H. pylori gastritis or both were present in over 75% of patients in each group. Results: After 1 and 3 months of treatment, mean hemoglobin in group A increased from 9.5 ± 1.2 to 11.2 ± 1.3 and 12.8 ± 1.3 g/dl, respectively. By comparison, in group B, the corresponding values increased from 9.3 ± 1.3 to 10.2 ± 1.5 (p = 0.019) and 11.1 ± 1.7 g/dl (p = 0.022). A favorable response, defined as a more than 2 g/dl increase in basal hemoglobin or hemoglobin exceeding 12 g/dl, was obtained in 33 of 39 patients in group A compared with only 18 of 39 in group B (p = 0.009). Because of treatment failure, 14 patients in group B were subsequently referred for intravenous ferric sucrose therapy versus only 3 in group A (p < 0.0001). Conversely, of 5 patients in group A managed by intravenous iron prior to referral, 4 became independent of parenteral iron after starting the duodenal formulation of ferrous glycine sulfate. Interpretation and Conclusions: In patients with iron deficiency anemia associated with autoimmune and H. pylori gastritis with a high rate of refractoriness to oral iron treatment, satisfactory response to a duodenal formulation of ferrous glycine sulfate can be elicited in the vast majority of cases, obviating the need for expensive, inconvenient and occasionally risky intravenous iron administration.

Refractory Iron-deficiency Anemia and Autoimmune Atrophic Gastritis in Pediatric Age Group

“…However, considering that Hp eradication is a simple and relatively innocuous procedure, our procedure is the regular search and treatment in case of positivity. 14,15 More controversial is the management of chronic gastric immunologic damage. Histologic follow-up of mucosal gastric injury can be carried out in a periodical and regular manner or punctually face indirect evidence of improvement or worsening of AG.…”

“…Review of gastric biopsy plaques was conducted in a blinded manner. AG was defined as a replacement of native glands by the connective tissue or intestinal-type epithelium 13,14 (Fig. 3).…”

“…Histologic Analysis of Gastric Biopsy Samples Using the Sydney Criteria[10][11][12][13][14] www.jpho-online.com | 137…”

How I treat unexplained refractory iron deficiency anemia

“…In some of our patients, serine ferrous sulfate and ferrous glycine sulfate elicited good responses when other iron preparations failed, but the relative advantage of these preparations still awaits objective evaluation by prospective randomized trials. 100 …”

Insights Into Pediatric Autoimmune Gastritis

“…In fact, IDA can be the first presentation of AIG, and can precede the clinical onset of pernicious anemia by several years (5). Thus, it seems to be an age‐related progression from iron deficiency to cobalamin depletion (6).…”