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Decreased treatment failure rates following duodenal release ferrous glycine sulfate in iron deficiency anemia associated with autoimmune gastritis and Helicobacter pylori gastritis.
Acta Haematol. 2007; 118(1):19-26.AH

Abstract

BACKGROUND AND OBJECTIVES

Since gastric acidity and ascorbate play a critical role in the solubilization and reduction of iron for subsequent absorption, the achlorhydria associated with autoimmune and Helicobacter pylori gastritis may explain the poor response of such patients to oral iron treatment. In order to circumvent this problem, we explored the therapeutic potential of a duodenal formulation of ferrous glycine sulfate consisting of micropellets that do not dissolve at the acid environment of the stomach but, owing to their solubility at a higher pH, discharge their content directly into the duodenum.

DESIGN AND METHODS

In a case-control study, the treatment results of 39 patients with iron deficiency anemia receiving a duodenal formulation of ferrous glycine sulfate (group A) were compared with the results of 39 patients receiving other oral iron compounds (group B). Autoimmune gastritis, H. pylori gastritis or both were present in over 75% of patients in each group.

RESULTS

After 1 and 3 months of treatment, mean hemoglobin in group A increased from 9.5 +/- 1.2 to 11.2 +/- 1.3 and 12.8 +/- 1.3 g/dl, respectively. By comparison, in group B, the corresponding values increased from 9.3 +/- 1.3 to 10.2 +/- 1.5 (p = 0.019) and 11.1 +/- 1.7 g/dl (p = 0.022). A favorable response, defined as a more than 2 g/dl increase in basal hemoglobin or hemoglobin exceeding 12 g/dl, was obtained in 33 of 39 patients in group A compared with only 18 of 39 in group B (p = 0.009). Because of treatment failure, 14 patients in group B were subsequently referred for intravenous ferric sucrose therapy versus only 3 in group A (p < 0.0001). Conversely, of 5 patients in group A managed by intravenous iron prior to referral, 4 became independent of parenteral iron after starting the duodenal formulation of ferrous glycine sulfate.

INTERPRETATION AND CONCLUSIONS

In patients with iron deficiency anemia associated with autoimmune and H. pylori gastritis with a high rate of refractoriness to oral iron treatment, satisfactory response to a duodenal formulation of ferrous glycine sulfate can be elicited in the vast majority of cases, obviating the need for expensive, inconvenient and occasionally risky intravenous iron administration.

Authors+Show Affiliations

Department of Hematology, Shaare Zedek Medical Center, Jerusalem, Israel. hershko@szmc.org.ilNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

17426393

Citation

Hershko, Chaim, et al. "Decreased Treatment Failure Rates Following Duodenal Release Ferrous Glycine Sulfate in Iron Deficiency Anemia Associated With Autoimmune Gastritis and Helicobacter Pylori Gastritis." Acta Haematologica, vol. 118, no. 1, 2007, pp. 19-26.
Hershko C, Ianculovich M, Souroujon M. Decreased treatment failure rates following duodenal release ferrous glycine sulfate in iron deficiency anemia associated with autoimmune gastritis and Helicobacter pylori gastritis. Acta Haematol. 2007;118(1):19-26.
Hershko, C., Ianculovich, M., & Souroujon, M. (2007). Decreased treatment failure rates following duodenal release ferrous glycine sulfate in iron deficiency anemia associated with autoimmune gastritis and Helicobacter pylori gastritis. Acta Haematologica, 118(1), 19-26.
Hershko C, Ianculovich M, Souroujon M. Decreased Treatment Failure Rates Following Duodenal Release Ferrous Glycine Sulfate in Iron Deficiency Anemia Associated With Autoimmune Gastritis and Helicobacter Pylori Gastritis. Acta Haematol. 2007;118(1):19-26. PubMed PMID: 17426393.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Decreased treatment failure rates following duodenal release ferrous glycine sulfate in iron deficiency anemia associated with autoimmune gastritis and Helicobacter pylori gastritis. AU - Hershko,Chaim, AU - Ianculovich,Mara, AU - Souroujon,Moshe, Y1 - 2007/04/10/ PY - 2007/01/03/received PY - 2007/01/29/accepted PY - 2007/4/12/pubmed PY - 2007/7/24/medline PY - 2007/4/12/entrez SP - 19 EP - 26 JF - Acta haematologica JO - Acta Haematol VL - 118 IS - 1 N2 - BACKGROUND AND OBJECTIVES: Since gastric acidity and ascorbate play a critical role in the solubilization and reduction of iron for subsequent absorption, the achlorhydria associated with autoimmune and Helicobacter pylori gastritis may explain the poor response of such patients to oral iron treatment. In order to circumvent this problem, we explored the therapeutic potential of a duodenal formulation of ferrous glycine sulfate consisting of micropellets that do not dissolve at the acid environment of the stomach but, owing to their solubility at a higher pH, discharge their content directly into the duodenum. DESIGN AND METHODS: In a case-control study, the treatment results of 39 patients with iron deficiency anemia receiving a duodenal formulation of ferrous glycine sulfate (group A) were compared with the results of 39 patients receiving other oral iron compounds (group B). Autoimmune gastritis, H. pylori gastritis or both were present in over 75% of patients in each group. RESULTS: After 1 and 3 months of treatment, mean hemoglobin in group A increased from 9.5 +/- 1.2 to 11.2 +/- 1.3 and 12.8 +/- 1.3 g/dl, respectively. By comparison, in group B, the corresponding values increased from 9.3 +/- 1.3 to 10.2 +/- 1.5 (p = 0.019) and 11.1 +/- 1.7 g/dl (p = 0.022). A favorable response, defined as a more than 2 g/dl increase in basal hemoglobin or hemoglobin exceeding 12 g/dl, was obtained in 33 of 39 patients in group A compared with only 18 of 39 in group B (p = 0.009). Because of treatment failure, 14 patients in group B were subsequently referred for intravenous ferric sucrose therapy versus only 3 in group A (p < 0.0001). Conversely, of 5 patients in group A managed by intravenous iron prior to referral, 4 became independent of parenteral iron after starting the duodenal formulation of ferrous glycine sulfate. INTERPRETATION AND CONCLUSIONS: In patients with iron deficiency anemia associated with autoimmune and H. pylori gastritis with a high rate of refractoriness to oral iron treatment, satisfactory response to a duodenal formulation of ferrous glycine sulfate can be elicited in the vast majority of cases, obviating the need for expensive, inconvenient and occasionally risky intravenous iron administration. SN - 1421-9662 UR - https://www.unboundmedicine.com/medline/citation/17426393/Decreased_treatment_failure_rates_following_duodenal_release_ferrous_glycine_sulfate_in_iron_deficiency_anemia_associated_with_autoimmune_gastritis_and_Helicobacter_pylori_gastritis_ L2 - https://www.karger.com?DOI=10.1159/000101701 DB - PRIME DP - Unbound Medicine ER -