Can Gastritis Be Brought On By Liquid Iron?

Iron pill-induced gastritis is a rare and under-recognized condition that can cause serious complications when ingestion of inorganic iron pills or tablets. These pills, which are crystalline coatings, can corrode the stomach’s lining, leading to erosions, inflammation, and bleeding. Patients with iron pill-induced gastritis should replace their iron pills or tablets with liquid iron, as they cause corrosive mucosal injury. Liquid iron does not produce the same adverse effect of mucosal ulceration and is a promising alternative therapy for those with iron deficiency anemia who are also suffering from this condition.

It is important to note that iron pill-induced gastritis only occurs when iron supplementation is given in the tablet or pill form due to the concentration effect. However, it has not been noted to occur in patients placed on a liquid form of iron supplementation. Iron pills or pills can deposit hemosiderin, which can erode gastric mucosa, causing localized ulceration. Iron pills or pills are thought to lead to a crystalline coating, which can corrode the stomach lining and cause erosions, inflammation, and bleeding.

In conclusion, iron pill-induced gastritis is a rare and under-diagnosed entity that can be present even at pediatric ages with potential severe clinical impact. It is crucial for healthcare providers to identify this entity and provide appropriate treatment for patients with iron gastropathy. Transitioning to liquid or IV iron should be considered in patients with iron gastropathy as the use of iron pills can lead to gastric erosions. Endoscopically, iron pill-induced gastritis manifests as erosions and ulcerations, similar to the focal erosive mucosal injury caused by oral iron tablets.

Is liquid iron better for gastritis?

A liquid form of iron supplement is much less toxic to the gastric mucosa than solid iron tablets are. A liquid formulation does not produce the same epithelial injury as the iron tablet does because the liquid formulation is unable to concentrate within the body to the same extent. This is why in animal studies, even after consuming a lethal serum level of a liquid iron supplement, these same animals do not exhibit any signs of mucosal erosion .

The findings of a second study by Haig and Driman, involving 16 gastric, four duodenal, and five esophageal biopsies, are consistent with what was observed in the patient we are presenting. This study noted though that the average age of patients with erosive damage was 43% higher (76 versus 53 years of age, P = 0. 002) in the group that was overloaded with iron compared to the group that was not. One epidemiological explanation for this would be that elderly patients are at greater risk for polypharmacy, gastric motility issues, and impediments to proper medication administration. Consequently, they are more likely to be taking iron pills, and by extension, are also more likely to develop supplemental iron-induced gastritis .

When examining the role of iron pills in upper gastrointestinal pathology, however, Kaye et al did not observe any significant associations with regard to age, gender, NSAID, or aspirin use. This retrospective study identified 59 patients, totaling 64 episodes of iron deposition. When further broken down, 86% (6/7) of patients with esophageal iron deposition displayed erosion, compared to the 63% (29/46) of patients with gastric iron deposition who had erosion and the 80% of patients (37/46) who had reactive gastritis. Perhaps most compelling of all though, this study determined that 98% of patients with iron deposition had a history of oral iron supplementation .

Can iron infusion cause gastritis?

Iron deficiency is the most common cause of anemia worldwide, and is often managed with various methods of iron supplementation. However, oral iron supplementation can perpetuate iron deficiency anemia by causing gastric ulceration and upper gastrointestinal bleeding in high-risk populations. This complication has not been previously described with intravenous iron supplementation. A case of a 63-year-old male with severe iron deficiency anemia, who presented with melena over several months, was presented. Upper endoscopy revealed a clean-based gastric body ulcer and nonbleeding gastric varices, suggesting iron-induced gastric mucosal injury. This case demonstrates that frequent utilization of intravenous iron and packed red blood cell transfusions may predispose certain patients to the development of iron-induced gastritis and ulceration. Iron-induced gastritis is a rare condition that is scarcely reported in the literature. Oral iron supplementation is the most conventional treatment modality for iron deficiency anemia, with intravenous iron and packed red blood cell transfusions reserved for specific circumstances such as oral iron intolerance, history of gastric surgery, chronic blood loss anemia, malabsorptive syndromes, and severe deficiency/anemia.

Is it safe to take liquid iron daily?

At high doses, iron is toxic. For adults and children ages 14 and up, the upper limit – the highest dose that can be taken safely – is 45 milligrams a day. Children under age 14 should not take more than 40 milligrams a day.

The American Academy of Pediatrics suggests that – starting at 4 months of age – full-term, breastfed infants should be supplemented each day with 1 milligram of oral iron per kilogram of body weight. This should continue until iron-containing complementary foods, such as iron-fortified cereals, are added to the diet. Standard infant formula that contains 12 milligrams per liter of iron can fulfill the iron needs of an infant until age 1.

Ask your health care provider how much iron supplement you or your child should take, if any.

Can iron overload cause gastritis?

The gold standard would be that the use of oral iron for the treatment of anemia should be avoided as it is unlikely to improve anemia and may exacerbate colonic inflammation increasing the risk of colorectal cancer in patients affected by chronic inflammatory bowel diseases. Also in gastric mucosa the iron has been detected in the interstitial space or in the macrophages but not in the cytoplasm of the epithelial gastric cells suggesting that it could be a factor inducing gastritis with the same mechanism hypothesized for colonic mucosa and could synergistically activate gastric interleukins promoting tumorigenesis. 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 ).

Conclusions. In consideration of histological aspects observed in our patients we believe that it is important to document these lesions in pathology reports to give a valid feedback to the clinicians in order to apply a correct follow-up and a better therapy, since liquid iron has been suggested as a valid and promising alternative to the current treatment. Finally, we hypothesize that iron intake in iron-induced gastric inflammation could play a potential tumorigenic role but further studies and reports will be necessary to validate these speculative hypotheses.

Acknowledgments. Authors’ note: A part of the present article has been presented as an abstract at the SIAPEC-IAP Italian Congress of Pathology, 2014, Florence, Italy.

Is it OK to take liquid iron everyday?

Some doctors may recommend taking iron supplements daily. Research from 2017 suggests that taking iron supplements every other day may better help with absorption. If you have iron deficiency anemia, talk about dosage with your doctor to help ensure you get the amount of this essential nutrient that you need.

Iron is an essential mineral for maintaining good health. Iron supplements are an excellent way to prevent complications of iron deficiency anemia.

If you think you may have iron deficiency anemia, talk with your doctor about whether iron supplements are right for you.

Can iron cause gastritis?

The World Health Organization reports that almost 25 percent of the world’s population has anemia, with iron deficiency being the most common type. Ferrous sulfate supplementation is commonly prescribed for these patients, but it can cause side effects like constipation, dark stools, and gastrointestinal irritation, often in the form of nausea. Iron pill gastritis is a documented complication of iron supplementation, but is rarely encountered. A prospective study by Kaye et al found that 6 out of 16 patients with iron deposition had visible erosions on endoscopy, a significantly greater proportion than those without iron supplementation. No significant differences were attributed to potential confounders such as age, gender, aspirin, and non-steroidal anti-inflammatory drug use.

Laine et al published a prospective evaluation of healthy volunteers who were separated into two groups, both of which had not had previous iron supplementation. Endoscopy showed a significant increase in endoscopic abnormalities of the stomach in patients who received iron therapy for a longer duration. Two patients had developed gastric ulcerations after iron therapy.

Iron pill-induced gastritis is an under-recognized, albeit serious entity that merits further investigation. Many patients diagnosed with iron pill gastritis have numerous comorbidities that may increase their susceptibility to this condition. Iron deposits a brown-black crystalline hemosiderin that erodes the mucosa, and it is thought that iron erodes the mucosa through a direct corrosive effect that subsequently produces a local injury to the mucosa in a concentration-dependent manner. Iron pill-induced gastritis only occurs when iron supplementation is given in the tablet or pill form, likely due to the concentration effect.

Does iron cause gastric irritation?

Iron is best absorbed on an empty stomach. Yet, iron supplements can cause stomach cramps, nausea, and diarrhea in some people. You may need to take iron with a small amount of food to avoid this problem.

Milk, calcium and antacids should not be taken at the same time as iron supplements. You should wait at least 2 hours after having these foods before taking your iron supplements.

Foods that you should not eat at the same time as you take your iron include:

• High fiber foods, such as whole grains, raw vegetables, and bran
• Foods or drinks with caffeine

Can liquid iron cause GERD?

Iron supplements can potentially aggravate GERD symptoms in some individuals.

Iron can be irritating to the gastrointestinal tract, and certain forms of iron supplements, such as ferrous sulfate, may cause gastrointestinal side effects like heartburn, stomach pain, and acid reflux.

GERD and anemia are distinct but interconnected conditions. GERD, characterized by chronic acid reflux, can lead to erosions in the esophagus and chronic blood loss, resulting in anemia.

Early identification and management of both conditions are important for better outcomes. If you think you have GERD or anemia — or both — consider reaching out to a healthcare professional to get a comprehensive evaluation.

Can I take iron if I have gastritis?

Oral iron supplementation is a common treatment for iron-deficiency anemia, but it can lead to iron pill-induced gastritis. This condition is crucial for diagnosing and should be replaced with liquid iron. Iron pills and tablets cause corrosive mucosal injury, and their effect is concentration-dependent. Liquid iron does not have the same side effect of promoting mucosal injury.

A 59-year-old male with Child-Pugh B cirrhosis, diabetes mellitus, hypertension, dyslipidemia, and chronic kidney disease presented for an upper gastrointestinal endoscopy for prophylactic variceal band ligation. He was receiving 325 mg of ferrous sulfate twice daily. His vital signs were normal, and his physical examination revealed splenomegaly. Blood work revealed hemoglobin 11. 4 g/dL, a normal mean corpuscular volume of 91 fL, iron saturation 14 (normal: 25–50), ferritin 88 ng/mL, and total iron binding capacity 339 μ/dL.

On upper endoscopy, the patient had esophageal varices in the distal esophagus and mild portal hypertensive gastropathy. A superficial 6-mm gastric ulcer was found, and biopsies revealed erosive gastritis. An iron stain showed heavy iron deposition consistent with iron pill-induced gastritis. The patient was started on an oral proton pump inhibitor and instructed to discontinue his oral iron tablets. He was started on a liquid iron preparation instead of the iron tablets.

A liver biopsy performed a few years prior to this presentation did not show any evidence of iron overload.

Can oral iron cause gastritis?

Oral iron supplements are commonly used to treat patients with iron deficiency anemia, but in rare cases, they can lead to more severe symptoms, known as “iron pill gastritis”. This condition is diagnosed when a patient receiving iron supplementation develops erosive gastritis with iron deposition on histopathology. Iron-induced mucosal injury is most common in the elderly, with only a few reported instances in young patients.

A 43-year-old woman with iron deficiency anemia and unmanaged gastroesophageal reflux disease (GERD) presented with melena and coffee-ground emesis. After her acute symptoms were resolved, she was administered oral iron supplementation with plans to follow-up in the outpatient setting. However, she rapidly developed upper GI bleeding and a severe, Helicobacter pylori (H. pylori)-negative gastritis with iron deposits on histology. This case serves as an important reminder that any patient receiving oral iron supplementation is at a risk for gastritis. It is essential to provide continued follow-up for patients receiving iron supplementation independent of age or comorbidity.

The patient presented to the emergency department complaining of intermittent melena and coffee-ground emesis for the past two weeks, as well as an unintentional 25-pound weight loss in recent months. She had been diagnosed with severe GERD approximately 18 months earlier, though she was not taking any medication. Physical examination was unremarkable, and lab work was significant only for normocytic anemia with hemoglobin of 10. 1 g/dl. Fetal occult blood testing was negative, LDH was within normal limits, and blood urea nitrogen to creatinine ratio was unremarkable at 14:1.

After her acute symptoms had resolved, the patient was started on oral ferrous sulfate of 325 mg BID and scheduled for a non-emergent endoscopy due to the likelihood of a potential GI bleed. An urgent esophagogastroduodenoscopy (EGD) revealed atrophic gastritis with nodular and thickened mucosa, multiple non-bleeding ulcerations in the gastric body, antrum, and prepyloric regions. Biopsies showed inflammation with pits of brown pigment consistent with iron gastropathy. Based on these observations and recent criteria regarding histologic subtypes for drug-induced GI lesions, the patient was diagnosed with an ischemic-type iron pill gastritis and oral ferrous sulfate was discontinued immediately.

Can iron irritate gastritis?

Oral iron supplements are commonly used to treat patients with iron deficiency anemia, but in rare cases, they can lead to more severe symptoms, known as “iron pill gastritis”. This condition is diagnosed when a patient receiving iron supplementation develops erosive gastritis with iron deposition on histopathology. Iron-induced mucosal injury is most common in the elderly, with only a few reported instances in young patients.

A 43-year-old woman with iron deficiency anemia and unmanaged gastroesophageal reflux disease (GERD) presented with melena and coffee-ground emesis. After her acute symptoms were resolved, she was administered oral iron supplementation with plans to follow-up in the outpatient setting. However, she rapidly developed upper GI bleeding and a severe, Helicobacter pylori (H. pylori)-negative gastritis with iron deposits on histology. This case serves as an important reminder that any patient receiving oral iron supplementation is at a risk for gastritis. It is essential to provide continued follow-up for patients receiving iron supplementation independent of age or comorbidity.

The patient presented to the emergency department complaining of intermittent melena and coffee-ground emesis for the past two weeks, as well as an unintentional 25-pound weight loss in recent months. She had been diagnosed with severe GERD approximately 18 months earlier, though she was not taking any medication. Physical examination was unremarkable, and lab work was significant only for normocytic anemia with hemoglobin of 10. 1 g/dl. Fetal occult blood testing was negative, LDH was within normal limits, and blood urea nitrogen to creatinine ratio was unremarkable at 14:1.

After her acute symptoms had resolved, the patient was started on oral ferrous sulfate of 325 mg BID and scheduled for a non-emergent endoscopy due to the likelihood of a potential GI bleed. An urgent esophagogastroduodenoscopy (EGD) revealed atrophic gastritis with nodular and thickened mucosa, multiple non-bleeding ulcerations in the gastric body, antrum, and prepyloric regions. Biopsies showed inflammation with pits of brown pigment consistent with iron gastropathy. Based on these observations and recent criteria regarding histologic subtypes for drug-induced GI lesions, the patient was diagnosed with an ischemic-type iron pill gastritis and oral ferrous sulfate was discontinued immediately.