Iron Deposits in the Gastric Mucosa: Prevalence and Clinicopathologic Associations.
Jennifer M Hurrell, Shelby D Melton, Robert M Genta. Caris Life Sciences, Irving, TX; UT Southwestern and Dallas VA Medical Center, TX
Background: Iron deposition in the mucosa of the upper gastrointestinal tract is an established complication of oral iron therapy. However, more information about its prevalence and clinicopathologic associations is needed.
Design: We searched the electronic database of a national pathology laboratory to identify patients who had a diagnosis of iron deposition in gastric biopsy specimens between 1/2008 and 8/2010. We then compared their demographic, clinical, endoscopic, and histopathologic data to those of patients who had a diagnosis of reactive gastropathy (RG) with or without erosions, but no evidence of iron deposits, during the same period.
Results: There were gastric biopsies from 326,539 patients (median age 53 years, range 0-101; 38.2% male); 41,317 patients (median age 62 years, range 15-91; 35.1% male) had a diagnosis of RG; 10,083 of these also had erosions or ulcers). Iron deposits were detected by the Prussian Blue stain in 378 patients (median age 66, range 15-91; 39% male). Compared to patients with RG, those with with iron deposition were older (66 versus 62 years, p<0.0001), were much more likely to have anemia as the main indication for endoscopy (42.8% versus 8.8%; OR 6.00 95%CI 4.85-7.43, p<.0001), and significantly less likely to present with GERD, dyspepsia, nausea, vomiting, or abdominal pain. Endoscopically, erosions or ulcers were noted in 29% of patients with iron deposition, 19% of RG patients with no histologic erosions, and in 56% of RG patients with histologic erosions. Concurrent H. pylori infection was present in 0.03% of patients with RG and in 2.4% of those with iron deposits (OR 9.03 95%CI 4.54-17.95; p<.0001). No patients had a concurrent diagnosis of pill esophagitis, but iron deposits were noted in the duodenal mucosa of 12 of 126 patients (9.6%) who had a simultaneous duodenal biopsy.
Conclusions: Iron was identified in 0.1% of all patients with gastric biopsies and in 0.9% of all those with RG. Since only Prussian Blue-confirmed deposits were included, the prevalence of this finding is likely to have been underestimated. A history of anemia was the only significant clinical association detected. In contrast to the notion than oral iron medications induce pain, patients with iron deposits had a much lower prevalence of dyspepsia, nausea, vomiting, or abdominal pain. The clinical significance of this histopathologic finding remains uncertain; studies are needed to determine whether iron is the cause of erosions or simply deposits in existing gastric lesions.
Tuesday, March 1, 2011 9:30 AM
Poster Session III # 143, Tuesday Morning