Iron-deficiency anemia is common condition most often treated with iron supplementation.
Ferrous sulfate supplementation in the pill or tablet form is the most commonly prescribed treatment for patients with iron deficiency anemia.
Common side effects of oral iron supplementation include constipation, dark stools, and gastrointestinal irritation (often in the form of nausea).
Iron pill–induced gastritis is an under-recognized, albeit serious entity that merits further investigation.
Particularly with other comorbid conditions such as gastric antral vascular ectasia and gastric adenocarcinoma, the degree of iron deposition extends to the lamina propria and even the gastric glands.
Iron has been noted to cause a focal erosive mucosal injury similar to that caused by a chemical burn.
Iron pill–induced gastritis only occurs when iron supplementation is given in the tablet or pill form likely because of the concentration effect and has not been noted to occur in patients who are on a parenteral iron supplementation.
Endoscopically, iron-pill gastritis manifests as erosions, ulcerations, or diffuse gastritis along with peculiar brownish-black mucosa.
Biopsy: shows features of reactive or chemical-type gastropathy or epithelial injury without significant inflammation. Characteristic foreign material adherent to the injured epithelial surface or sometimes present deeper within the mucosa is often evident. Iron pill material can have a variable or mixed appearance on the H&E stain. Commonly, it appears as a yellow-brown crystalline refractory material, but it can also appear purple-blue or blue-black and more smudgy. The material may only be focally present within the biopsy. An iron stain can help confirm the diagnosis. Although iron pill injury is most commonly encountered in the stomach, it can also occur in the esophagus and duodenum.
Treatment: substituting oral iron by parenteral iron formulation.
References
Hashash JG, Proksell S, Kuan SF, Behari J. Iron pill–induced gastritis. ACG Case Rep J. 2013;1: 13–15.
Xue Y, Farris AB, Quigley B, Krasinskas A. The impact of new technologic and molecular advances in the daily practice of gastrointestinal and hepatobiliary pathology. Arch Pathol Lab Med. 2017;141:517-527.
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