P2839 - Iron Pill Associated Gastritis With Positional Emesis and Unique Endoscopic Findings

Courtney Hanlon, MD¹, Patrick Chan, MD¹, Nicholas Placone, MD^2
1University of Southern California, Los Angeles, CA; ²Keck School of Medicine of USC, Los Angeles, CA

Introduction: This is a rare case of endoscopically significant findings from a commonly used medication. The patient’s unique clinical and endoscopic presentation provide relevant learning for all who treat iron deficiency anemia.

Case Description/Methods: This is a 41 year old woman with a history of group I pulmonary artery hypertension and resultant right ventricular failure on home milrinone, and iron deficiency anemia. She presents with 2 weeks of epigastric pain, nausea, and non-bloody emesis. The pain is intermittent, sharp, lasting 5-10 seconds, and associated with shortness of breath with no relation to meal intake. The nausea is more prominent when lying down. On multiple occasions she had woken up in the morning or middle of the night with nausea causing her to vomit.

She has no history of dysphagia or GERD symptoms. An esophagram as part of a lung transplant workup demonstrated mild esophageal dysmotility and a small hiatal hernia. Prior gastric emptying study was unremarkable. She has no melena, hematochezia, constipation, or diarrhea. Her home medications include oral aspirin, ferrous sulfate, furosemide, spironolactone, midodrine, opsumit, and sildenafil, as well as intravenous epoprostenol and milrinone.

She had only mild tenderness upon palpation of the epigastrium. Abdominal ultrasound showed a structurally unremarkable hepatobiliary system with cholelithiasis. Computed tomography was negative for gastrointestinal abnormality. EGD revealed discrete ovoid violaceous erosions on the posterior wall of the gastric body. Biopsies showed gastric iron deposition on biopsy consistent with iron pill-induced gastritis. These findings were thought to be the source of the patient’s nausea and positional discomfort; her oral iron was discontinued and her symptoms resolved.

Discussion: Although oral iron pills are a common medication used by gastroenterologists worldwide, this case presents an interesting and clinically significant complication of a medication whose adverse effects are thought to be well known. While iron deposition on hematoxylin and eosin stain of gastric or esophageal biopsies is not uncommon in patients on iron pills, what is rare is the endoscopic findings, paired with the patients severe positional symptoms. Beyond the commonly discussed side effects of constipation and change in stool color, gastritis and related symptoms such be discussed with patients as a rare but known potential side effect of oral iron therapy.



Disclosures:


Courtney Hanlon, MD¹, Patrick Chan, MD¹, Nicholas Placone, MD². P2839 - Iron Pill Associated Gastritis With Positional Emesis and Unique Endoscopic Findings, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.