Iron pill induced gastritis causing severe anemia
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CASE REPORT
Iron pill induced gastritis causing severe anemia Kiran Motwani1 · Jonah Rubin2 · Harris Yfantis3 · Megan Willard4 Received: 18 November 2019 / Accepted: 19 May 2020 © Japanese Society of Gastroenterology 2020
Abstract Iron supplementation is ubiquitously prescribed and considered a benign means of therapy. However, side effects such as iron pill gastritis can be life threatening prompting discontinuation. We describe a case of a 71-year-old man who presents with severe iron deficiency anemia on oral iron therapy. Esophagogastroduodenoscopy revealed mucosal injury in the fundus, including erythema and ulceration. Biopsy of the area was significant for pill debris. After switching to intravenous iron supplementation, his gastric mucosa healed and anemia improved. This case demonstrates the rare life-threatening side effect of iron pills causing corrosive mucosal damage and significant anemia from gastrointestinal bleeding. Keywords Iron deficiency anemia · Gastrointestinal bleeding · Gastric · Endoscopy
Introduction
Case report
Iron deficiency is the most common etiology of anemia [1]. Empiric treatment for iron deficiency anemia without referral to a gastroenterologist is concerning because gastrointestinal malignancy is on the differential diagnosis. Oral iron supplementation is the first-line treatment because it is a cost-effective therapy. We describe an under-recognized and rare adverse effect of oral iron supplementation causing serious corrosive gastric ulcerations and erosive gastritis resulting in gastrointestinal bleeding and worsening anemia.
A 71-year-old male with a history of chronic kidney disease, coronary artery disease and hypertension presented for evaluation of persistent anemia. He denied having hematochezia, melena, abdominal pain, vomiting, bleeding or bruising. The patient had not had any recent acute illnesses, undergone surgery, or suffered any injury or trauma. He reported that he was not drinking alcohol or taking nonsteroidal anti-inflammatory drugs or corticosteroids. Hemoglobin was initially 9.3 g/dL with a mean corpuscular volume of 77 fL. Peripheral smear revealed microcytosis and hypochromia. White blood cell and platelet counts were normal. Serum iron was 13 mcg/dL, serum ferritin was 5 ng/mL and iron saturation was 3%. Serum vitamin B12 and folate levels were both within the normal reference range. Liver function tests and blood clotting function were normal, and renal function was consistent with stage IIIA chronic kidney disease. Prior screening colonoscopies had been normal and did not reveal any precancerous polyps. He was diagnosed with iron deficiency anemia and empirically started on ferrous sulfate 325 mg twice a day prior to being referred to a gastroenterologist for anemia evaluation. Four months after starting iron therapy, the patient had an esophagogastroduodenoscopy and colonoscopy, which were normal. He subsequently had a video capsule endoscopy, which was significant for a few small bowel angiodysplasias. With treatment, his hemoglobin and iro
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