Iron-induced esophageal ulceration

Areia, Miguel; Gradiz, R.; Souto, P.; Camacho, Eduardo; Silva, M. R.; Almeida, Nuno; Rosa, André Ricardo Pereira da; M, Cunha; Leitão, MJ

doi:10.1055/s-2007-966820

Cited by 13 publications

(5 citation statements)

References 5 publications

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“…The main presenting symptoms of our patients were odynophagia, retrosternal pain and dysphagia. This is in agreement with other reports, where retrosternal pain, odynophagia and dysphagia are the most frequently reported symptoms also [ 5 , 11 ]. Heartburn ranged as the fourth commonest symptom.…”

Section: Discussionsupporting

confidence: 94%

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Pill –Induced Erosive Esophagitis in Children

et al. 2014

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AimsPill-induced esophagitis has been recognized in adults, but rarely in children. The aim of this article is to discuss endoscopic features, drugs implicated, prevention and treatment in pill-induced esophagitis in children.Patients and methodsOver a period of 4 years, 26 patients presented at our clinic with drug-induced esophageal ulcerations. All patients were diagnosed by means of endoscopy and treated with proton-pump inhibitors and prokinetics. The mean age of the children was 10.76 years.ResultsThe ulcers were frequently located at the mid-esophagus. Odynophagea, retrosternal pain and dysphagia were the most common presenting symptoms. All children took pills (non-steroidal anti-inflammatory drugs, antibiotics – Doxycycline and ferrous sulfate) with little water and at bed time. The mean elapse between the drug intake and endoscopy was 4.96 days. The symptoms resolved within a maximum of one week of antireflux therapy.ConclusionsIn pediatric cases treated by tablets or capsules, the possibility of medication-induced esophagitis should always be considered. The drug-induced esophagitis should be suspected in all patients presenting with chest pain and dysphagia. Physicians must warn the patients to take the pills and capsules with enough water and in the upright position.

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Section: Discussionsupporting

confidence: 94%

“…Esophagitis is the most frequent esophageal disorder in children. Around 90 % of drug-induced esophagitis occur after use of non-steroidal anti-inflammatory drugs, antibiotics – doxycycline and ferrous sulfate [ 1 , 2 , 3 , 4 , 5 ]. Retrosternal pain, odynophagia and dysphagia are the most frequently reported symptoms.…”

Section: Introductionmentioning

confidence: 99%

Pill –Induced Erosive Esophagitis in Children

et al. 2014

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“… 11 , 12 However, therapeutic doses of ferrous salts have been shown to cause severe gastric and esophageal injury. 13 – 15 In IBD patients, FS has been shown to worsen the inflammatory state in the colon 16 and has been suggested to trigger ulcerative colitis. 17 Similarly, FF has been shown to worsen the symptoms in patients affected by Crohn’s disease.…”

Section: Introductionmentioning

confidence: 99%

Ferrous sulfate, but not iron polymaltose complex, aggravates local and systemic inflammation and oxidative stress in dextran sodium sulfate-induced colitis in rats

Toblli¹,

Cao²,

Angerosa³

2015

DDDT

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Background and aimsIron deficiency is common in inflammatory bowel disease, yet oral iron therapy may worsen the disease symptoms and increase systemic and local oxidative stress. The aim of this study was to compare the effects of oral ferrous sulfate and iron polymaltose complex on inflammatory and oxidative stress markers in colitic rats.MethodsAnimals were divided into four groups with ten animals each. Rats of three groups received dextran sodium sulfate to induce colitis and animals of two of these groups received 5 mg iron/kg of body weight a day, as ferrous sulfate or iron polymaltose complex, for 7 days. Gross colon anatomy, histology of colon and liver, stainings of L-ferritin, Prussian blue, hepcidin, tumor necrosis factor-α, and interleukin-6, as well serum levels of liver enzymes, inflammatory markers, and iron markers, were assessed.ResultsBody weight, gross anatomy, crypt injury and inflammation scores, inflammatory parameters in liver and colon, as well as serum and liver hepcidin levels were not significantly different between colitic animals without iron treatment and colitic animals treated with iron polymaltose complex. In contrast, ferrous sulfate treatment caused significant worsening of these parameters. As opposed to ferrous sulfate, iron polymaltose complex caused less or no additional oxidative stress in the colon and liver compared to colitic animals without iron treatment.ConclusionIron polymaltose complex had negligible effects on colonic tissue erosion, local or systemic oxidative stress, and local or systemic inflammation, even at high therapeutic doses, and may thus represent a valuable oral treatment of iron deficiency in inflammatory bowel disease.

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“…The mucosal toxicity of ferrous sulfate has also been reported for the hypopharynx,12 the esophageal lumen,13 and (after inhalation of a tablet) the tracheobronchial tree 14,15…”

Section: Discussionmentioning

confidence: 88%

Ulceration of the oral mucosa following direct contact with ferrous sulfate in elderly patients: a case report and a review of the French National Pharmacovigilance Database

Liabeuf¹,

Gras²,

Moragny³

et al. 2014

CIA

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ObjectiveTo report a series of cases of ulceration of the oral mucosa linked to direct contact with ferrous sulfate in elderly patients.Case summaryThe first case report concerns the occurrence of widespread oral ulceration in an 87-year-old woman with Alzheimer’s disease. The ulceration extended from the side of the tongue to the floor of the mouth. No clear explanation was found and various local treatments were ineffective. Once it was realized that the ferrous sulfate tablets (given as an iron supplement) were crushed prior to administration (due to the patient’s deglutition disorder), withdrawal of this treatment led to rapid resolution of the ulceration. Nine other cases of oral ulcerations associated with ferrous sulfate were identified in the French National Pharmacovigilance Database. All but one of the patients were over 80 years of age and the youngest patient (a 54-year-old) had dysphagia associated with facial paralysis.DiscussionOnly two other reports of oral ulceration due to ferrous sulfate have been published to date. Mucosal toxicity of ferrous sulfate (which is probably related to oxidative stress) has previously been reported for the hypopharynx, the esophageal lumen, and (after inhalation of a tablet) the tracheobronchial tree.ConclusionThe mucosal toxicity of ferrous sulfate must be taken into account when deglutition disorders are present (as in elderly patients) and appropriate pharmaceutical formulations (such as syrups) should be administered to at-risk patients. The use of iron salts other than ferrous sulfate could be considered.

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Iron-induced esophageal ulceration

Cited by 13 publications

References 5 publications

Pill –Induced Erosive Esophagitis in Children

Pill –Induced Erosive Esophagitis in Children

Ferrous sulfate, but not iron polymaltose complex, aggravates local and systemic inflammation and oxidative stress in dextran sodium sulfate-induced colitis in rats

Ulceration of the oral mucosa following direct contact with ferrous sulfate in elderly patients: a case report and a review of the French National Pharmacovigilance Database

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