Iron-induced mucosal pathology of the upper gastrointestinal tract: a common finding in patients on oral iron therapy

Aims: Upper gastrointestinal injury from iron tablets at therapeutic dose is not widely recognized. The aim was to document cases of iron-related upper gastrointestinal (GI) pathology and to determine frequency of occurrence. Methods and results: We prospectively studied patients with iron deficiency anaemia undergoing upper GI endoscopy from November 2005 to July 2006. Cases of upper GI iron deposition from these and other cases extracted retrospectively between 1999 and 2006 were examined histopathologically and patient notes were reviewed. In the prospective study, 15/160 patients investigated for iron deficiency anaemia [16.1% (15/93) of those taking oral iron tablets] had iron deposition noted on routine haematoxylin and eosin staining. In this plus the retrospective series, 59 patients were identified with 64 episodes of iron deposition. Eighty-six percent (6/7) with oesophageal iron deposition had associated erosion. Sixty-three percent (29/46) with gastric iron deposition had erosion and 80% (37/46) had reactive gastritis. Duodenal deposition was usually (91%, 10/11) within macrophages in villous tips with no erosion. Ninety-eight percent (58/59) of iron deposition cases had documented oral iron intake. Conclusions: Iron deposition in the upper GI tract is common in patients taking iron tablets. It is frequently associated with mucosal disruption in the oesophagus and stomach.