Iron Pill Gastritis: An Under Diagnosed Condition With Potentially Serious Outcomes

Abstract

Given the ubiquitous use of oral iron therapy, their side effects are often encountered and well recognized in clinical practice. However, iron pill gastritis remains an often under-reported and elusive diagnosis. An astute clinician should be aware of this condition in order to promptly discontinue oral iron and institute timely treatment. Here in, we present a case of a 46-year-old woman who presented to the gastroenterology clinic with vague epigastric pain and microcytic anemia. Esophagogastroduodenoscopy revealed multiple gastric erosions and non-bleeding gastric antral ulcer with biopsies showing excessive iron deposition suggestive of iron pill gastritis. We reviewed the clinical features, pathology, and treatment of iron pill gastritis along with the review of the literature.

Iron Overload in Gastric Mucosa: Underdiagnosed Condition Rarely Documented in Clinical and Pathology Reports

“…In contrast, other studies have demonstrated that a liquid form of iron supplement is less damaging for the gastric mucosa than solid forms. In fact the liquid form of iron does not concentrate within gastrointestinal mucosa: animal experiments demonstrated the absence of signs of mucosal damage even if lethal ferrous serum level was detected [9][10].…”

Gastric Siderosis and Ulceration from Intravenous Iron Supplementation Manifesting as Chronic Upper Gastrointestinal Bleeding: A Case Report and Review of the Literature

“…In developed countries, the frequent use of aspirin and nonsteroidal anti-inflammatory drugs has become a more common cause of PUD [7]. Iron-induced gastric ulcers are a rare phenomenon and are previously reported in association with oral iron pill therapy [3–5]. To our knowledge, there are no reported cases in the literature demonstrating gastritis or gastric ulceration due to intravenous iron or PRBC transfusions.…”

“…Adverse effects of oral iron therapy may include a metallic taste, nausea, constipation, diarrhea, and flatulence; nonetheless it is generally well tolerated [2]. Uncommon but potentially serious adverse effects are chronic gastritis, ulceration, and bleeding secondary to oxidative damage to the gastric mucosa [3–5].…”

Pattern of Blood Products Transfusions and Reactions among Multi-Transfused Haemophiliacs in Nigeria : Implications on Haemophilia Care in Low Resource Tropical Settings

“…This is because one of the side effects of iron therapy is erosive gastritis and gastric bleeding, which are commonly associated with iron pills, but not with liquid iron preparations. (30) In view of this risk, we recommend that iron-deficient haemophiliacs, irrespective of their ages, should preferably be treated with liquid iron preparations as they are less toxic to the gastric mucosa. (30) Second, a previous study has identified the lack of adequate use of pharmacological agents such as desmopressin and the anti-fibrinolytic agents (epsilon amino caproic acid and tranexamic acid) as a major limitation in the management of haemophilia in tropical developing countries.…”