S5173 Iron Pill Gastritis: An Under-Recognized Cause of Gastritis

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Introduction: Gastritis is often caused by an infectious agent (Helicobacter pylori) or an immune-mediated process (autoimmune gastritis). Iron pill-induced gastritis is a frequently overlooked etiology of gastritis, despite the frequent use of oral iron therapy in clinical practice. Here we present a case of iron pill-induced gastritis following ferrous gluconate supplementation. Case Description/Methods: A 36-year-old man initially presented to the hospital with hematemesis and melena. He was regularly taking oral ferrous gluconate 324 mg daily following a diagnosis of low serum iron level on routine blood work. During his hospitalization, the patient underwent esophagogastroduodenoscopy (EGD), which revealed LA grade D esophagitis, and gastric ulceration. Gastric biopsies demonstrated focal mild chronic gastritis, without H. pylori. The patient was discharged on omeprazole 40 mg twice daily and iron supplementation. A follow-up EGD 3 months later showed resolution of the esophagitis and the absence of previously observed gastric ulcer. However, a few superficial gastric ulcers with no signs of bleeding were noted in the gastric body, prompting further biopsies. Histological examination revealed ulceration with crystalline deposition, consistent with iron pill gastritis (Figure 1). Oral iron supplementation was immediately discontinued, and the patient was maintained on proton pump inhibitor therapy with the plan to repeat EGD in the next 3 months. Discussion: This case underscores the significance of recognizing iron pill-induced gastritis, a complication that is often underestimated in the context of oral iron supplementation for treating iron deficiency.Figure 1.: A: A few superficial gastric ulcers found within the gastric body during repeat Esophagogastroduodenoscopy (EGD). B, C, D: Gastric mucosal histopathology demonstrating ulceration and brown crystalline iron deposition. Magnification in B is 100X, magnification in C is 200X, and magnification in D is 400X.

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