Pseudomelanosis Duodeni Appearing after Oral Iron Therapy

Pseudomelanosis duodeni is a rare condition characterized by the endoscopic appearance of diffuse dark pigmentation of the duodenal mucosa. It is typically seen in older women and has been reported to be associated with hypertension, chronic renal disease, diabetes mellitus, gastrointestinal hemorrhage, and the use of medications such as oral iron, furosemide, thiazide, hydralazine, and propranolol. We present a case of pseudomelanosis duodeni appearing after 2 years of oral iron therapy in an 85-year-old woman. Although oral iron supplementation seemed the strongest possible etiology, our patient had multiple comorbidities and was on other medications that have been described as associations. The majority of individuals taking oral iron or under these clinical conditions do not develop this entity; some other factors in patients may be responsible for its occurrence.

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IRON ABSORPTION AND RESPONSE TO ORAL IRON THERAPY IN IRON DEFICIENCY ANEMIA ASSOCIATED TO ASYMPTOMATIC GIARDIASIS.

Pediatric Research ◽

10.1203/00006450-199306000-00039 ◽

1993 ◽

Vol 33 (6) ◽

pp. 661-661

Author(s):

Helena U Suzuki ◽

Mauro B Morais ◽

Jose N Corral ◽

Ulisses Fagundes-Neto ◽

Nelson L Machado

Keyword(s):

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Iron Absorption ◽

Oral Iron ◽

Iron Therapy ◽

Deficiency Anemia ◽

Oral Iron Therapy

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Poor efficacy of oral iron replacement therapy in pediatric patients with heart failure

Cardiology in the Young ◽

10.1017/s1047951121004066 ◽

2021 ◽

pp. 1-8

Author(s):

Kriti Puri ◽

Joseph A. Spinner ◽

Jacquelyn M. Powers ◽

Susan W. Denfield ◽

Hari P. Tunuguntla ◽

...

Keyword(s):

Heart Failure ◽

Iron Deficiency ◽

Transferrin Saturation ◽

Systolic Heart Failure ◽

Oral Iron ◽

Wilcoxon Test ◽

Iron Therapy ◽

Oral Iron Therapy ◽

Iron Deficient ◽

Iron Replacement

Abstract Introduction: Iron deficiency is associated with worse outcomes in children and adults with systolic heart failure. While oral iron replacement has been shown to be ineffective in adults with heart failure, its efficacy in children with heart failure is unknown. We hypothesised that oral iron would be ineffective in replenishing iron stores in ≥50% of children with heart failure. Methods: We performed a single-centre retrospective cohort study of patients aged ≤21 years with systolic heart failure and iron deficiency who received oral iron between 01/2013 and 04/2019. Iron deficiency was defined as ≥2 of the following: serum iron <50 mcg/dL, serum ferritin <20 ng/mL, transferrin >300 ng/mL, transferrin saturation <15%. Iron studies and haematologic indices pre- and post-iron therapy were compared using paired-samples Wilcoxon test. Results: Fifty-one children with systolic heart failure and iron deficiency (median age 11 years, 49% female) met inclusion criteria. Heart failure aetiologies included cardiomyopathy (51%), congenital heart disease (37%), and history of heart transplantation with graft dysfunction (12%). Median dose of oral iron therapy was 2.9 mg/kg/day of elemental iron, prescribed for a median duration of 96 days. Follow-up iron testing was available for 20 patients, of whom 55% (11/20) remained iron deficient despite oral iron therapy. Conclusions: This is the first report on the efficacy of oral iron therapy in children with heart failure. Over half of the children with heart failure did not respond to oral iron and remained iron deficient.

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Small Bowel Pseudomelanosis Associated with Oral Iron Therapy

Journal of Korean Medical Science ◽

10.3346/jkms.2013.28.7.1103 ◽

2013 ◽

Vol 28 (7) ◽

pp. 1103 ◽

Cited By ~ 6

Author(s):

Seung Young Kim ◽

Rok Seon Choung ◽

Bo Sung Kwon ◽

Jong Jin Hyun ◽

Sung Woo Jung ◽

...

Keyword(s):

Small Bowel ◽

Oral Iron ◽

Iron Therapy ◽

Oral Iron Therapy

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Esophageal ridges: an unusual complication of oral iron therapy

Annals of Gastroenterology ◽

10.20524/aog.2017.0124 ◽

2017 ◽

Author(s):

Vishal Sharma

Keyword(s):

Oral Iron ◽

Iron Therapy ◽

Unusual Complication ◽

Oral Iron Therapy

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Comparative Study of the Effects of Lactoferrin versus Oral Iron Therapy in Obese Children and Adolescents with Iron Deficiency Anemia

Journal of Advances in Medicine and Medical Research ◽

10.9734/jammr/2021/v33i2131138 ◽

2021 ◽

pp. 104-114

Author(s):

Manal Mahmoud Atia ◽

Rasha Mohamed Gama ◽

Mohamed Attia Saad ◽

Mohammed Amr Hamam

Keyword(s):

Iron Deficiency ◽

Children And Adolescents ◽

Iron Deficiency Anemia ◽

Interleukin 6 ◽

Oral Iron ◽

Iron Therapy ◽

Deficiency Anemia ◽

Obese Children ◽

Oral Iron Therapy ◽

Serum Hepcidin

Greater prevalence of iron deficiency (ID) has been observed in overweight and obese children and adolescents. Hepcidin acts as a key regulator of iron metabolism. Hepcidin synthesis increases in response inflammatory cytokines especially Interleukin-6 (IL-6). Considering that obesity represents a low grade chronic inflammatory state, a high concentration of hepcidin has been found in obese children. Elevated hepcidin level in obese children is associated with diminished response to oral iron therapy. Lactoferrin is an iron-binding multifunctional glycoprotein and has strong capacity to modulate the inflammatory response by its capacity to reduce pro-inflammatory cytokine expression in vivo, including IL-6 and hepcidin. Aim of the Work: To compare the efficacy of lactoferrin versus oral iron therapy in treatment of obese children and adolescents with iron deficiency anemia and the effect of therapy on serum hepcidin and interleukin 6 levels. Methodology: This prospective randomized clinical trial was conducted on 40 obese children and adolescents aged between 6 –18 years suffering from iron deficiency anemia (IDA). They were equally randomized into one of 2 groups. Group A received regular oral lactoferrin in a dose of 100 mg/day. Group B received regular oral iron supplementation (Ferric hydroxide polymaltose) in a dose of 6 mg elemental iron/kg /day.Baseline investigations included complete blood count (CBC), iron profile (Serum ferritin, serum iron, total iron binding capacity (TIBC), transferrin saturation), serum Interleukin 6, and serum hepcidin. Reevaluation of CBC was done monthly while iron status parameters, serum IL-6 and serum hepcidin were reevaluated after 3 months of receiving regular therapy. Results: Significant elevations in hemoglobin, MCV, MCH, Serum ferritin, serum iron and transferrin saturation with lactoferrin therapy compared to oral iron therapy. Significantly Lower TIBC after 3 months of lactoferrin therapy while the decrease in TIBC was insignificant in the iron therapy group.Lower serum hepcidin and IL6 after 3 months of lactoferrin therapy with no significant change in serum hepcidin and IL6 after iron therapy. Conclusion: This study clearly demonstrated the superiority of lactoferrin over iron use as oral in the treatment of iron deficiency anemia in obese children not only for the better response of hematological and iron status parameters and less gastrointestinal side effects but also for its effect on decreasing inflammatory biomarkers as hepcidin and IL6.

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