Can Gastritis Result From Taking Iron Supplements?

Iron supplementation can lead to iron pill-induced gastritis, a potentially serious complication. The mechanism for this gastritis involves iron oxidation and damage to the esophagus and stomach. Iron pills, which are a crystalline coating of inorganic iron, can corrode the stomach lining, causing erosions and gastrointestinal irritation. Common side effects of oral iron supplementation include constipation, dark stools, and nausea. Iron pill gastritis is a rare, under-diagnosed entity that can be present even at pediatric ages with potential severe clinical impact.

Oral iron supplementation is generally well-tolerated, causing only mild adverse effects. However, iron supplements can cause gastric mucosal injury erosions even in people with a healthy GI system and can sometimes exacerbate problems in patients with unabsorbed iron. The incidence of iron pill gastritis is as high as 1 in the literature, typically presenting with shallow, small erosions in the esophageal and gastric mucosa.

Gastropathy is a common cause of gastric siderosis due to oral iron tablets, leading to iron pill-induced gastritis. Iron supplementation is a rare and under-diagnosed entity that can have a significant impact on patients’ health.

Can iron tablets cause gastric problems?

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

How to heal iron pill 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.

When to stop iron supplements?

• Do not take iron supplements by mouth if you are receiving iron injections. To do so may result in iron poisoning.
• Do not regularly take large amounts of iron for longer than 6 months without checking with your health care professional. People differ in their need for iron, and those with certain medical conditions can gradually become poisoned by taking too much iron over a period of time.

Iron pills can change the color of your stool to a greenish or grayish black. This is normal, but because internal bleeding can also cause dark stool, be sure to mention any color changes to your doctor.

If you think you or anyone else has taken an overdose of iron medicine :

What are the side effects of taking iron supplements?

Adverse Effects. The most common side effects are gastrointestinal, such as nausea/vomiting, constipation or diarrhea, flatulence, metallic taste, staining of the teeth, or epigastric distress. Patients may feel uncomfortable with the change in stool caliber and color to green or ‘tarry black.’ Many oral iron supplements (ferrous fumarate, ferrous gluconate, ferrous sulfate) formulations are associated with higher GI side effects than IV iron or placebo. Patients can decrease the adverse effects by taking iron supplements on an adjusted regimen (i. e., three times a week instead of daily), or taking it with food, although this may decrease the absorption and be less convenient for the patient, which may lead to non-compliance.

The adverse effects of IV iron may be infusion reactions and anaphylaxis.

Iron may decrease the absorption of other medications by forming an insoluble complex with those agents. These include methyldopa/levodopa, fluoroquinolones, penicillin, or tetracyclines.

How should you take iron supplements to avoid gastric upset?

For best absorption, the recommendation is to take iron at least 30 minutes before a meal or 2 hours before taking other medications.

If the patient cannot tolerate the gastrointestinal side effects, they may take it with small amounts of food.

Avoid taking it with milk, calcium, and antacids, high fiber foods, or caffeine.

Some studies have suggested taking iron with orange juice or with vitamin C supplementation to help improve absorption.

Can supplements cause gastritis?

Vitamins and supplements can also aggravate gastroesophageal reflux disease, peptic ulcers, gastritis, irritable bowel syndrome and other digestive conditions, Dr. Lee says. People with these conditions might be even more likely to have upset stomach, diarrhea, reflux or nausea from taking vitamins – especially ones that contain calcium, vitamin C or iron, which are more likely than others to irritate the stomach lining.

Rarely, vitamins and supplements can affect the way certain medications are absorbed or metabolized in the body. Make sure to discuss any vitamins you’re taking with your healthcare provider.

Tips to skip the stomach ache. DO take vitamins with food. If you have a hard time eating first thing in the morning, try taking your vitamins in the evening, with dinner, instead. “Taking them with food enhances the body’s ability to absorb the vitamins and decreases your risk of experiencing nausea and upset stomach,” Dr. Lee says.

Can iron tablets worsen IBS?

Can I take iron supplements if I have IBS? Yes, you can take iron supplements when your IBS is in remission. But it’s important to speak with a doctor first, as some forms of iron supplements may worsen IBS symptoms.

While anemia is not a typical symptom of IBS, people with IBS may develop anemia if they cannot absorb enough iron from their food.

Irritable bowel syndrome (IBS) is a common gastrointestinal disorder that affects the intestines.

IBS is characterized by symptoms such as bloating, abdominal pain, diarrhea, and constipation and is often associated with changes in bowel movements.

Can iron supplements cause gut inflammation?

Bastide et al. showed that heme iron plays a leading role in mucin-depleted foci (MDF) formation . Moreover, some gut strains, such as Bacteroides fragilis, can use heme iron directly . Various studies have shown the effect of iron intake on intestinal microbiota composition; for example, the six months consumption of iron-supplemented biscuits by anaemic African children caused a potentially more pathogenic gut microbiota profile and increased inflammation. There was also a significant growth of enterobacteria and a reduced amount of lactobacilli when compared to the control group receiving non-supplemented biscuits . In Kenya, infants were given iron-fortified micronutrient powder, which also caused significant changes in the intestinal microbiota, increasing enterobacteria and decreasing lactobacilli, resulting in inflammation as evidenced by an increase in faecal calprotectin . The described mechanisms are summarised in Figure 4.

Mechanisms of heme iron induction of colorectal carcinogenesis. NOCs— N -nitroso compounds; ROS—reactive oxygen species.

4. 2. Dysbiosis and Cancerogenesis. The bacterial strains that dominate in the colon during dysbiosis contribute to DNA damage, suppression of apoptosis by affecting multiple signalling pathways, and the production of pro-inflammatory cytokines or toxic metabolites. The microbes activate the NF-kB (nuclear factor-κB) pathway via the host Toll-like receptors (TLRs), initiating carcinogenesis due to the inhibition of apoptosis in enterocytes. Moreover, the activated NF-kB pathway causes an increase in the production of pro-inflammatory cytokines, TNF-α, IL-1, IL-6, IL-8 and anti-apoptotic genes . NF-kB activation is also possible via the increased production of secondary bile acids, which cause an increase in reactive oxygen, the direct activator of the NF-kB signalling pathway .

Can too much iron affect your stomach?

Can iron be harmful?. Yes, iron can be harmful if you get too much. In healthy people, taking high doses of iron supplements (especially on an empty stomach) can cause an upset stomach, constipation, nausea, abdominal pain, vomiting, and diarrhea. Large amounts of iron might also cause more serious effects, including inflammation of the stomach lining and ulcers. High doses of iron can also decrease zinc absorption. Extremely high doses of iron (in the hundreds or thousands of mg) can cause organ failure, coma, convulsions, and death. Child-proof packaging and warning labels on iron supplements have greatly reduced the number of accidental iron poisonings in children.

Some people have an inherited condition called hemochromatosis that causes toxic levels of iron to build up in their bodies. Without medical treatment, people with hereditary hemochromatosis can develop serious problems such as liver cirrhosis, liver cancer, and heart disease. People with this disorder should avoid using iron supplements and vitamin C supplements.

The daily upper limits for iron include intakes from all sources—food, beverages, and supplements—and are listed below. A doctor might prescribe more than the upper limit of iron to people who need higher doses for a while to treat iron deficiency.

Is it okay to just stop taking iron tablets?

Iron supplements typically begin working within 14 days. Some may notice improvements more quickly than this. To replenish low iron stores in the body, people need to take iron supplements for a minimum of 3 months.

Once iron stores and hemoglobin levels have increased, doctors may recommend that people continue taking iron supplements for another month. This helps increase the stores of iron in the body in case the person’s levels start to drop again.

Whether a person will keep feeling better after stopping iron pills will depend on what was causing their anemia. If they begin getting enough iron in their diet, or they lost blood due to an injury that is now healing, they may not need iron supplements in the future.

If doctors have not identified the cause, though, the anemia may come back.

Do iron supplements increase stomach acid?

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.