Stomach

Other nonneoplastic

Iron pill gastritis / pill gastritis



Last author update: 26 January 2023
Last staff update: 26 January 2023

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PubMed Search: Iron pill gastritis

Satyapal Chahar, M.D.
Monica T. Garcia-Buitrago, M.D.
Page views in 2022: 3,406
Page views in 2023 to date: 389
Cite this page: Chahar S, Garcia-Buitrago MT. Iron pill gastritis / pill gastritis. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/stomachiron.html. Accessed January 28th, 2023.
Definition / general
  • Corrosive injury to gastric mucosa secondary to oral iron supplement intake
Essential features
  • History of oral iron supplement use for iron deficiency anemia
  • Nausea, vomiting and epigastric pain
  • Mucosal injury with crystalline brown pigmented material deposition
Terminology
  • Pill gastritis
ICD coding
  • ICD-10:
    • K29.60 - other gastritis without bleeding
    • T45.4X5A - adverse effect of iron and its compounds, initial encounter
Epidemiology
Sites
  • Stomach
  • Gastroesophageal junction
  • Esophagus and duodenum
Pathophysiology
  • Deposition of brown-black inorganic iron crystals on the surface and formation of reactive oxygen metabolites that have corrosive, thrombotic and inflammatory properties (Gastroenterology Res 2017;10:138)
Etiology
  • Iatrogenic oral iron supplements (pills or tablets)
Clinical features
Diagnosis
  • Upper endoscopy with biopsy
Laboratory
  • Microcytic hypochromic anemia
Prognostic factors
Case reports
Treatment
  • Discontinuing use of the oral iron medication (ACG Case Rep J 2013;1:13)
  • Switch to less toxic form, such as liquid iron preparation
  • Intravenous iron supplementation
Clinical images

Contributed by Monica Garcia-Buitrago, M.D.
Iron pill gastritis

Gastric mucosa

Gross description
Microscopic (histologic) description
  • Mucosal injury in the form of erosion, ulceration and granulation tissue, according to the extent of the injury (Arch Pathol Lab Med 2004;128:821)
  • Acute inflammation in surrounding tissue, inflammatory exudate and reactive epithelial changes
  • Crystalline, metallic, brown-black pigmented material deposition in the superficial mucosa and ulcer bed
  • Iron is refractile but does not polarize
Microscopic (histologic) images

Contributed by Monica Garcia-Buitrago, M.D. and Domenika Ortiz, M.D.
Brown crystalline iron deposition Brown crystalline iron deposition Brown crystalline iron deposition

Brown crystalline iron deposition

Prussian blue stain Prussian blue stain

Prussian blue stain


Mucosal calcinosis

Mucosal calcinosis

Mucosal calcinosis von Kossa stain

Mucosal calcinosis von Kossa stain

Nonspecific pill gastritis

Nonspecific pill gastritis

Negative stains
Sample pathology report
  • Stomach, biopsy:
    • Acute gastritis with ulceration and crystalline, brown pigmented material deposition, consistent with iron pill gastritis (see comment)
    • Comment: A Prussian blue stain confirmed that the brown pigmented material is crystalline iron deposits.
Differential diagnosis
Board review style question #1

A microphotograph of a gastric biopsy of a 68 year old woman with a history of iron deficiency anemia is shown above. What is the most likely diagnosis?

  1. Autoimmune gastritis
  2. Helicobacter pylori gastritis
  3. Iron pill gastritis
  4. Proton pump inhibitor (PPI) changes
  5. Reactive gastropathy
Board review style answer #1
C. Iron pill gastritis. Gastric mucosa with acute inflammation, mucosal erosion and crystalline brown pigmented material deposition.

Comment Here

Reference: Iron pill gastritis / pill gastritis
Board review style question #2

An 82 year old patient with a history of iron deficiency anemia on oral iron supplement presented with vague epigastric pain and erythema on endoscopy. What is the most appropriate special stain for the biopsy specimen?

  1. Congo red
  2. Grocott methenamine silver stain
  3. Periodic acid-Schiff stain
  4. Prussian blue stain
  5. Warthin starry stain
Board review style answer #2
D. Prussian blue stain, which highlights the crystalline iron deposition in the superficial gastric mucosa

Comment Here

Reference: Iron pill gastritis / pill gastritis
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