The Ohio State University Wexner Medical Center Columbus, OH
Haider Saeed, MD, Judy Daboul, MD The Ohio State University Wexner Medical Center, Columbus, OH
Introduction: Oral iron supplementation is widely used and we often overlook its side effects. In severe cases, oral iron supplementation can cause mucosal injury to the gastrointestinal tract leading to symptoms of vague abdominal pain. In reported cases, immediate cessation of oral iron supplementation leads to resolution of the mucosal injury. In this case report, we examine the case of a female patient with cirrhosis and history of recurrent gastric antral vascular ectasia (GAVE) who developed a large circumferential gastric mass induced by iron pills supplementation, which resolved completely on cessation of the iron pills. This is a unique complication of iron supplementation which is likely underdiagnosed.
Case Description/Methods: We present an 80 year old female with past medical history relevant for recurrent gastric antral vascular ectasia (GAVE), iron deficiency anemia, and decompensated cirrhosis secondary to NASH who presented as a transfer from an outside hospital with one day of hematochezia and abdominal pain. She underwent EGD which revealed a likely malignant gastric tumor in the gastric antrum with contact oozing. This was impinging on the pylorus (Figure 1). Biopsy of the specimen revealed erosive iron pill gastritis with reactive epithelial and stromal change which was negative for malignancy. After discontinuation of iron pill supplements, repeat EGD in 1 month revealed full resolution of the gastric mass.
Discussion: The current prevalence of iron-pill-induced gastritis is about 0.7%. The mechanism of injury to the gastric mucosa involves oxidative damage when iron converts from its ferrous to ferric state. Most often, patients complain of abdominal pain and nausea. Our case is unique because our patient presented with hematochezia and was found to have a large bleeding circumferential mass. Given the history of GAVE, we suspect that ectatic vessels are at higher risk of oxidative damage which may contribute to higher risk of developing a gastric mass, though the mechanism is poorly understood. Unfortunately, there is not much data to support who is at higher risk of developing iron pill gastritis when given at normal doses. Our case presents a unique complication of oral iron supplementation which is often not considered when patients present with abdominal pain. We can use this case to study the nature of gastric tumors arising from iron supplementation and identify risk factors for developing these masses.
Figure: Figure 1. A large, infiltrative and ulcerated, partially circumferential mass with contact bleeding in the gastric antrum secondary to iron pill gastritis.
Disclosures:
Haider Saeed indicated no relevant financial relationships.
Judy Daboul indicated no relevant financial relationships.
Haider Saeed, MD, Judy Daboul, MD. P4201 - Bleeding Gastric Mass Induced by Iron Pills Supplementation, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.
