P4238 - A Rare Case of Iron Pill-Associated Gastropathy With Anemia

Eric Gochanour, MD¹, Neel Vahil, MD², David Martin, MD¹, Sameen Khalid, MD¹, Swathi Paleti, MD^1
1University of New Mexio, Albuquerque, NM; ²University of New Mexico Health Sciences Center, Albuquerque, NM

Introduction: We present a case of iron pill-associated gastropathy in a patient presenting with severe, acute anemia.

Case Description/Methods: A 66-year-old female with history of multiple sclerosis, alcohol use disorder presented to the emergency department for fatigue and weakness. Medication history includes ferrous sulfate and methotrexate. On physical exam, she was frail, thin with conjunctival pallor, blood pressure was 104/60 mm Hg and heart rate 95. Pertinent labs on admission include a hemoglobin (hgb) of 4.7 g/dL, elevated BUN-33 mmol/L, serum iron-30 mcg/dL, TIBC-189 mcg/dL, % saturation-16 and normal ferritin -137 ng/ml. She was transfused 2 units of packed red blood cells with improvement in her hemoglobin. She underwent an upper endoscopy which showed multiple large, non-bleeding ulcers in the stomach and duodenum (Figures 1a and 1b) which were the likely source of her anemia. Biopsies from the edges of the gastric ulcer showed reactive iron gastropathy with focal erosion on H&E stain (Figure 1c) which was confirmed with iron stain (Figure 1d). Random gastric biopsies were negative for H.pylori. A colonoscopy was done but was aborted due to poor bowel preparation. After the biopsy results were reviewed, the iron supplementation was discontinued, and the patient was scheduled for an outpatient follow up in the clinic.

Discussion: Iron associated gastropathy is a rare, likely underdiagnosed entity. Multiple side effects of iron-supplementation are well known including nausea, constipation, and dark stools. In addition, iron has long been recognized as a toxin on the gastrointestinal tract when studied in the setting of iron overdose. Multiple studies have shown iron deposition can be seen in up to 1% of biopsies from the upper GI tract including the esophagus, stomach and duodenum



Diagnosis is based on endoscopic and histological findings as clinical presentation is nonspecific. Our case highlights the importance of clinicians to be aware of potential complications of iron supplementation and the critical role of pathologists in making the diagnosis of iron pill-associated gastropathy. It is important to recognize this potential side-effect of iron supplementation, as complications can be severe and potentially life threatening such as gastrointestinal hemorrhage. Treatment includes discontinuing iron pills or switching to liquid iron which leads to resolution of gastropathy.



Disclosures:


Eric Gochanour, MD¹, Neel Vahil, MD², David Martin, MD¹, Sameen Khalid, MD¹, Swathi Paleti, MD¹. P4238 - A Rare Case of Iron Pill-Associated Gastropathy With Anemia, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.