Malabsorption of hemoglobin iron in pernicious anemia: correction with intrinsic factor—containing substances

Waxman, Samuel; Pratt, Peter W.; Herbert, Victor

doi:10.1172/jci105871

Cited by 16 publications

(7 citation statements)

References 26 publications

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“…The degree to which heme iron contained in natural meat is malabsorbed by achlorhydric patients has apparently not been studied, but the available evidence (84) indicates that the absorption of heme iron contained in hemoglobin is reduced by half in patients with IDA who are achlorhydric. By using the results of isotopic studies with intrinsic tagging, we calculated that an achlorhydric man consuming a typical Western diet would be in negative iron balance that would reduce body iron content.…”

Section: Discussionmentioning

confidence: 99%

“…These results are questionable because isotopic absorption was measured by subtracting isotopic recovery in stool from oral intake of isotope and because there is no evidence that stools were collected under closely supervised conditions. Waxman et al (84) used wholebody counting to measure the absorption of isotopically labeled heme iron in hemoglobin. Absorption in iron-deficient patients who secreted gastric acid averaged 19.6%, whereas achlorhydric patients with iron deficiency absorbed 10.4%.…”

Section: Effect Of Achlorhydria On Iron Absorption From Heme and Hemomentioning

confidence: 99%

“…This malabsorption was corrected by normal gastric juice (10.4-23.3%) but not by gastric juice from patients with PA (10.4-11.9%). Thus, in the setting of iron deficiency, achlorhydric patients absorbed pure heme iron normally (69), but they malabsorbed heme iron contained in hemoglobin (84).…”

Section: Effect Of Achlorhydria On Iron Absorption From Heme and Hemomentioning

confidence: 99%

“…Acid-secreting patients with IDA absorbed an average of 24.1% of nonheme iron in bread and absorbed 1.5% if they were achlorhydric (69). As a surrogate for the absorption of heme iron from natural meat we used the absorption of heme iron contained in hemoglobin as reported by Waxman et al (84) (i.e., 10.0% in normal subjects, 19.6% in acidsecreting patients with iron deficiency, and 10.4% in achlorhydric patients with iron deficiency). No information was found with regard to heme-iron absorption in achlorhydric non-iron-deficient patients, so we assumed their absorption would be equal to that in normal acid-secreting subjects (i.e., 10%).…”

Section: Effect Of Achlorhydria On Iron Absorption From Heme and Hemomentioning

confidence: 99%

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Is achlorhydria a cause of iron deficiency anemia?

Betesh

Ana

Cole

et al. 2015

The American Journal of Clinical Nutrition

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We re-evaluated the old hypothesis that gastritis-induced achlorhydria is a cause of iron deficiency anemia (IDA) in humans. First, we analyzed the currently available research on the association between achlorhydria and IDA. When gastric acid secretion was measured after maximal stimulation, the frequency of achlorhydria (or severe hypochlorhydria) was 44% in patients with idiopathic IDA and 1.8% in healthy controls. In some patients with pernicious anemia, presumed achlorhydria preceded the development of IDA in time. However, we found no credible evidence that IDA caused gastritis or that IDA preceded the development of achlorhydria. Thus, correlational results favor achlorhydria as the causal factor in the association between achlorhydria and IDA. Second, we sought to determine whether gastritis and achlorhydria cause negative iron balance. When biosynthetic methods were used to isotopically label iron in food, achlorhydric patients were found to have severe malabsorption of nonheme iron, which persisted after the development of IDA. In 1 study, achlorhydria reduced the normal increase in heme-iron absorption from hemoglobin in response to iron deficiency. After an injection of isotopic iron into normal men, the physiologic loss of iron from the body was found to be 1 mg/d. Patients with chronic gastritis had excess fecal loss of isotopically tagged plasma iron. Calculations based on these results indicate that the absorption of iron from a typical Western diet by achlorhydric patients would be less than physiologic iron losses, creating a negative iron balance that could not be overcome by the adaptive increase in duodenal iron absorptive capacity that occurs in response to iron deficiency. The combination of results from these correlational and pathophysiologic studies supports the hypothesis that gastritis-induced achlorhydria can be an independent cause of IDA.

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Section: Discussionmentioning

confidence: 99%

Section: Effect Of Achlorhydria On Iron Absorption From Heme and Hemomentioning

confidence: 99%

Section: Effect Of Achlorhydria On Iron Absorption From Heme and Hemomentioning

confidence: 99%

Section: Effect Of Achlorhydria On Iron Absorption From Heme and Hemomentioning

confidence: 99%

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Is achlorhydria a cause of iron deficiency anemia?

Betesh

Ana

Cole

et al. 2015

The American Journal of Clinical Nutrition

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“…The effect of gastric juice on inorganic iron absorption may be a function of hydrochlo ric acid [5] or other constituents [6], Studies on the role of gastric juice in hemoglobin iron absorption are controversial. Intrinsic factor, however, does play a major role in complexing hemoglobin iron and serving as an intestinal transport factor for heme [7].…”

mentioning

confidence: 99%

No Malabsorption of Inorganic Ferrous Iron in Patients with Achylia gastrica

1979

Acta Haematol

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Factors affecting iron balance

Conrad

Barton

1981

American J Hematol

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The availability of radioisotopes of iron led to the performance of physiologic studies of the absorption, excretion, and kinetics of iron. The effects of dietary constituents and intestinal secretions upon iron absorption have been thoroughly explored and have permitted the development of tools for nutritional studies in various geographic areas of the world. The basic mechanisms for regulation of iron absorption are not fully understood. However, the isolation and characterization of newer iron-binding proteins, the existence of mucosal receptors in which there is competition for iron-binding sites with other metals, and the identification of a number of animal models with genetic abnormalities of iron absorption provide promise for development in the foreseeable future. The means by which the body informs the intestine to increase or decrease iron absorption is poorly understood, and the abnormality in hemochromatosis and iron overloading disorders remains unexplained. Much has been learned in recent years regarding the structure of iron-containing proteins and the variations that exist in different species. Similar problems remain to be solved with regard to the intermediary metabolism of iron in red blood cell precursors and other cells in the body. It is postulated that the combined usage of physiologic, biochemical, and immunologic investigations will provide the basic information required.

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Malabsorption of hemoglobin iron in pernicious anemia: correction with intrinsic factor—containing substances

Cited by 16 publications

References 26 publications

Is achlorhydria a cause of iron deficiency anemia?

Is achlorhydria a cause of iron deficiency anemia?

No Malabsorption of Inorganic Ferrous Iron in Patients with Achylia gastrica

Factors affecting iron balance

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