title: Decreased treatment failure rates following duodenal release ferrous glycine sulfate in iron deficiency anemia associated with autoimmune gastritis and Helicobacter pylori gastritis.
abstract: OBJECTIVE
  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.
  
  
  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.
  
  
  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.affiliation: Department of Hematology, Shaare Zedek Medical Center, Jerusalem, Israel. hershko@szmc.org.il
authors.forename: Chaim
authors.initials: C
authors.lastname: Hershko
authors.forename: Mara
authors.initials: M
authors.lastname: Ianculovich
authors.forename: Moshe
authors.initials: M
authors.lastname: Souroujon
mesh_terms: D000284:Administration, Oral; D000328:Adult; D018798:Anemia, Iron-Deficiency / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D016022:Case-Control Studies; D002626:Chemistry, Pharmaceutical; D003692:Delayed-Action Preparations; D004386:Duodenum / Q000378:metabolism; D005260:Female; D005296:Ferrous Compounds / Q000008:administration & dosage* / Q000494:pharmacology; D005500:Follow-Up Studies; D005757:Gastritis, Atrophic / Q000150:complications* / Q000175:diagnosis / Q000276:immunology; D016481:Helicobacter Infections / Q000150:complications* / Q000175:diagnosis; D016480:Helicobacter pylori / Q000302:isolation & purification; D006801:Humans; D007408:Intestinal Absorption; D058085:Iron Compounds / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D011336:Probability; D012016:Reference Values; D012307:Risk Factors; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D003692:Delayed-Action Preparations; D005296:Ferrous Compounds; D058085:Iron Compounds; C020748:ferrous sulfate