Oral Iron Absorption Test Research Articles

The Role of Hepcidin and an Oral Iron Absorption Test in Identifying the Root Cause of Iron-Restricted Anemia (Enter-Iron)

Introduction: Traditional iron parameters often fail to distinguish the cause of iron-restricted anemia in patients without an obvious underlying cause. We evaluated whether an oral iron absorption test (OIAT) and hepcidin measurement could be useful diagnostic tests in these patients. Methods: We retrospectively analyzed data extracted from medical records of all patients who underwent an OIAT and hepcidin measurement, noting subsequent clinical diagnosis. Δ Iron >15 µmol/L during the OIAT and a hepcidin level below the median (or suppressed ≤0.5 nm) were considered appropriate. Results: Thirty-nine adult patients were included in the study. Sixteen patients with adequate OIAT had suppressed hepcidin levels indicative of classical iron-deficiency anemia (IDA); 59% of patients had abnormal OIAT. In this group, most patients with low hepcidin levels had anemia associated with abnormalities in the gastrointestinal tract, whereas 83.3% patients with high hepcidin levels had iron-refractory iron-deficiency anemia (IRIDA), confirmed by genetic testing. Finally, transferrin/log ferritin ratio accurately identified patients with suppressed hepcidin: AUC 0.98 [95% CI: 0.95–1.02], p < 0.001. Conclusion: OIAT differentiates between classical IDA and other types of anemia caused by abnormalities in iron absorption or systemic iron availability. Additionally, elevated hepcidin in patients with oral iron malabsorption could indicate IRIDA.

Oral iron absorption test: myth or reality?

Oral iron absorption test: myth or reality?

A test to measure oral iron absorption and glucose tolerance simultaneously in 18 to 55 year old premenopausal women

Several methods are available to measure iron absorption (IA). The oral iron absorption test (OIAT) measures IA based on a change in serum iron (ΔSeFe) concentration after an oral iron dose. The objective of this study was to validate the OIAT by comparing it to the reference method of fractional iron absorption (FIA) using red blood cell incorporation of stable iron isotopes from a labeled iron dose. A second objective was to assess whether the OIAT could be done simultaneously with an oral glucose tolerance test (OGTT), since iron deficiency and glucose intolerance may coexist, especially among overweight individuals with low-grade inflammation. In this prospective experimental study, 116 women were enrolled and IA was measured using two different approaches 1) FIA from a labeled test meal containing 6mg of 57Fe and 2) the OIAT assessing ΔSeFe at 2h after the intake of 100mg oral iron, done simultaneously with an OGTT. Markers of iron status, glycaemia and inflammation, and serum hepcidin, were measured. Prevalence of anemia and iron deficiency (defined as low serum ferritin) were 21% and 14%, respectively. ΔSeFe during the OIAT-OGTT was positively associated with FIA (r=0.578, p<0.001). ΔSeFe was not significantly correlated with markers of glucose and insulin metabolism during the OIAT-OGTT. The combined OIAT and OGTT method described here correlates well with FIA measured by stable iron isotopes, and could provide information on both IA and glucose tolerance in a single 2-h test, decreasing the burden on patients. clinicaltrials.gov (NCT03642223).

Effect of iron deficiency level on oral iron absorption

目的研究铁缺乏症患者缺铁程度对口服铁剂吸收的影响。方法纳入2018年7月至2020年6月于中国医学科学院血液病医院贫血中心门诊就诊并确诊铁缺乏症的非妊娠期女性患者37例，以13例健康查体女性为正常对照，分析缺铁性贫血（IDA）、缺铁性红细胞生成/储存铁不足（IDE/ID）患者及正常对照者Hepcidin水平并进行口服铁剂吸收试验（OIAT），比较服铁后2 h血清铁（C2）与基线血清铁（C0）差值。结果IDA、ID/IDE、正常对照组Hepcidin中位数分别为4.9（2.17～32.86）、26.98（11.02～49.71）、69.89（42.23～138.96）µg/L（P<0.001），IDA组Hepcidin低于ID/IDE组（校正后P＝0.005）和正常对照组（校正后P<0.001），但ID/IDE组与正常对照组差异无统计学意义（校正后P＝0.220）；OIAT IDA、ID/IDE及正常对照组C2–C0平均值分别为（35.30±21.68）、（37.90±14.06）、（23.57±10.14）µmol/L，差异无统计学意义（P＝0.130）。多重线性回归分析显示C0、血清铁蛋白（SF）、可溶性转铁蛋白受体（sTFR）和HGB是铁缺乏症患者Hepcidin的独立影响因素，Hepcidin＝−31.842−0.642*C0+2.239*SF+1.778*sTFR+0.365*HGB−0.274*网织红细胞血红蛋白含量（RET-HB）。未发现C2–C0的独立影响因素。结论铁缺乏程度影响口服铁剂吸收，胃肠功能正常者铁缺乏越重，口服铁剂吸收越多，ID/IDE较IDA铁吸收减缓。Hepcidin较OIAT更能区分不同铁缺乏程度的口服铁吸收。

Increased iron absorption in patients with chronic heart failure and iron deficiency

BackgroundIron deficiency (ID) is common in patients with chronic heart failure (CHF), but the underlying causes are not fully understood. We investigated whether ID is associated with decreased iron absorption in patients with CHF. Methods and ResultsWe performed an oral iron-absorption test in 30 patients and 12 controls. The patients had CHF with reduced (n = 15) or preserved (n = 15) ejection fraction and ID, defined as s-ferritin < 100 µg/L, or s-ferritin 100–299 µg/L and transferrin saturation < 20%. The controls had no HF or ID and were of similar age and gender. Blood samples were taken before and 2 hours after ingestion of 100 mg ferroglycin sulphate. The primary endpoint was the delta plasma iron at 2 hours. The delta plasma iron was higher in the group with HF than in the control group (median increase 83.8 [61.5;128.5] µg/dL in HF vs 47.5 [30.7;61.5] µg/dL in controls, P = 0.001), indicating increased iron absorption. There was no significant difference between the groups with preserved or reduced ejection fraction (P = 0.46). ConclusionWe found increased iron absorption in patients with CHF and ID compared to controls without ID and HF, indicating that reduced iron absorption is not a primary cause of the high prevalence of ID in patients with CHF. Clinical Trial RegistrationEudraCT 2017-000158-21

Feralgine™ a New Approach for Iron Deficiency Anemia in Celiac Patients.

Background: Celiac disease (CD) is an immunologically-mediated disorder characterized by duodenal mucosa villi atrophy. Iron absorption is usually reduced in celiac patients making every kind of oral iron treatment unhelpful because of malasorption. Feralgine™ is a new product that has been demonstrated to be more bioavailable. As such, the aim of our study was to evaluate the absorption of Feralgine™ in adult patients with CD. Methods: Twenty-six adults affected by Iron Deficiency Anemia (IDA), of which 14 were also affected by CD and 12 were not affected by CD, were enrolled. An oral iron absorption test (OIAT) was performed in each patient by administrating Feralgine™, and serum iron was evaluated at baseline (T0) and after 2 h (T1) from the oral iron ingestion. Results: The OIAT was well tolerated in all patients, and, surprisingly, an equivalent statistically significant improvement in serum iron occurred in the two groups of patients (IDA plus CD: T0 = 28.21 µg/dL vs. T1 = 94.14 µg/dL p = 0.004 and IDA without CD: T0 = 34.91 µg/dL vs. T1 = 118.83 µg/dL, p = 0.0003). Conclusions: These results demonstrated the high absorption of Feralgine™ in celiac patients, confirming our previous data obtained with Ferrous Bysglicinate in children with CD.

Increased Duodenal Iron Absorption through Upregulation of Ferroportin 1 due to the Decrement in Serum Hepcidin in Patients with Chronic Hepatitis C.

Hepatic iron accumulation is generally increased in the chronic hepatitis C (CHC) liver; however, the precise mechanism of such accumulation remains unclear. We evaluated iron absorption from the gastrointestinal tract of patients with CHC and control participants. We measured the expression of a panel of molecules associated with duodenal iron absorption and serum hepcidin levels to determine the mechanism of iron accumulation in the CHC liver. We enrolled 24 patients with CHC and 9 patients with chronic gastritis without Helicobacter pylori infection or an iron metabolism disorder as control participants. An oral iron absorption test (OIAT) was administered which involved a dosage of 100 mg of sodium ferrous citrate. Serum level of hepcidin-25 was measured by liquid chromatography-tandem mass spectrometry. Ferroportin 1 (FPN) mRNA was measured by RT-PCR and FPN protein was analyzed by western blot. Samples were obtained from duodenum biopsy tissue from each CHC patient and control participant. Caco-2/TC7 cells were incubated in Costar transwells (0.4 μm pores). The OIAT showed significantly greater iron absorption in CHC patients than control participants. Serum hepcidin-25 in the CHC group was significantly lower than in the control group. Compared with control participants, duodenal FPN mRNA expression in CHC patients was significantly upregulated. The FPN mRNA levels and protein levels increased significantly in Caco-2/TC7 cell monolayers cultured in transwells with hepcidin. Lower serum hepcidin-25 levels might upregulate not only FPN protein expression but also mRNA expression in the duodenum and cause iron accumulation in patients with CHC.

Baseline hepcidin measurement in the differential diagnosis of anaemia for elderly patients and its correlation with the increment of transferrin saturation following an oral iron absorption test.

Background Anaemia is often multifactorial in the elderly, with a frequent association between iron deficiency anaemia (IDA) and anaemia of chronic disease (ACD). The primary objective of our study was to investigate whether baseline hepcidin measurement could be useful for identifying iron deficiency (ID) in anaemic elderly patients. The secondary objective was to assess whether baseline hepcidin concentrations correlated with the relative increase of transferrin saturation (TS) after an oral iron absorption test (OIAT). Methods Blood samples were collected between 7:30 am and 10:00 am in 328 geriatric outpatients, 102 underwent the OIAT. Types of anaemia were classified according biochemical and clinical criteria. TS and hepcidin were measured at baseline and 4 h after the iron dose. The ability of baseline hepcidin measurement to highlight ID in elderly anaemic patients was assessed using a receiver operator curve (ROC) analysis. Correlations between baseline hepcidin levels and the increment of TS following the OIAT were investigated using the Spearman coefficient. Results Among 328 included patients, 78 (23.8%) suffered from anaemia; 13 (4.0%), 19 (5.8%), 27 (8.2%) and 19 (5.8%) patients fulfilled criteria for IDA, IDA/ACD, ACD and unexplained anaemia, respectively. By multivariable analysis, creatinine, C-reactive protein, ferritin, Delta TS and Delta hepcidin were independently associated with baseline hepcidin concentrations. The area under the ROC curve (95% confidence interval) was 0.900 (0.830-0.970) for baseline hepcidin measurement. Baseline hepcidin levels correlated negatively with the relative increase in TS with a Spearman coefficient of -0.742. Conclusions Baseline hepcidin levels could be a useful tool to identify ID in anaemic elderly patients and may predict acute iron response following OIAT.

The Cost-effective Usefulness of Oral Iron Absorption Test- Prospective Evaluation in Premenopausal Women with Newly Diagnosed Iron Deficiency Anemia

The Cost-effective Usefulness of Oral Iron Absorption Test- Prospective Evaluation in Premenopausal Women with Newly Diagnosed Iron Deficiency Anemia

Oral Iron Absorption Test (OIAT): A Forgotten Screening Test for Iron Absorption from the Gastrointestinal Tract. A Case Series of 14 Iron Deficiency Anemia (IDA) Patients Treated with FERALGINE®

Oral Iron Absorption Test (OIAT): A Forgotten Screening Test for Iron Absorption from the Gastrointestinal Tract. A Case Series of 14 Iron Deficiency Anemia (IDA) Patients Treated with FERALGINE®

Oral iron absorption test with ferrous bisglycinate chelate in children with celiac disease.

Celiac disease (CD) is an immunologically-mediated enteropathy resulting in small-bowel mucosal villous atrophy with crypt hyperplasia. Iron malabsorption is usually observed in CD. Only few studies investigated oral iron absorption in subjects with gastrointestinal diseases and Iron Deficiency Anemia (IDA), using the oral iron absorption test (OIAT). We considered useful to investigate the OIAT, using ferrous bisglycinate chelate (FBC), in patients with CD at diagnosis or on gluten free diet (GFD) from at least 1 year. A total of 25 patients with CD (3-18 years old) and iron depletion, at diagnosis of CD (N.=12) or on GFD from at least 12 months (N.=13), were considered. Serum iron was evaluated at baseline (T0) and after 3 hours (T1) from the oral iron ingestion. Statistical analyses were conducted using SPSS 21.0 software for Mac. OIAT was well tolerated by all patients. An important increase of the serum iron at T1, of at least twice the baseline values, occurred in all patients except in one (P value <0.0005). These results demonstrated good efficacy of the FBC, not only in patients with CD on GFD but also in children with newly diagnosed CD with the characteristic intestinal lesions.

Increased duodenal iron absorption through up-regulation of divalent metal transporter 1 from enhancement of iron regulatory protein 1 activity in patients with nonalcoholic steatohepatitis.

Increased hepatic iron accumulation is thought to be involved in the pathogenesis of nonalcoholic steatohepatitis (NASH). Hepatic iron accumulation, as well as oxidative DNA damage, is significantly increased in NASH livers. However, the precise mechanism of iron accumulation in the NASH liver remains unclear. In this study, 40 cases with a diagnosis of NASH (n = 25) or simple steatosis (SS; n = 15) by liver biopsy were enrolled. An oral iron absorption test (OIAT) was used, in which 100 mg of sodium ferrous citrate was administered to each individual. The OIAT showed that absorption of iron from the gastrointestinal (GI) tract was increased significantly in NASH patients, compared to SS and control subjects. Iron reduction therapy was effective in patients with NASH, who exhibited iron deposition in the liver and no alanine aminotransferase improvement after other therapies (n = 9). Serum hepcidin concentration and messenger RNA (mRNA) levels of divalent metal transporter 1 (DMT1) also were significantly elevated in patients with NASH. OIAT results were correlated with grade of liver iron accumulation and DMT1 mRNA levels. Then, we demonstrated that DMT1 mRNA levels increased significantly in Caco-2/TC7 cell monolayers cultured in transwells with serum from NASH patients. An electrophoresis mobility shift assay showed activation of iron regulatory protein (IRP) in those cells, and IRP1 small interfering RNA clearly inhibited the increase of DMT1 mRNA levels. In spite of elevation of serum hepcidin, iron absorption from the GI tract increased through up-regulation of DMT1 by IRP1 activation by humoral factor(s) in sera of patients with NASH.

Oral iron absorption test in children with celiac disease and iron deficiency anemia: New insight for a forgotten test

Objective: Iron deficiency anemia (IDA) is very common in children with celiac disease (CD). In literature, only few old studies have investigated the oral iron absorption test (OIAT) in CD children with IDA to evaluate iron absorption. Our study aims to determine the absorption and the bioavailability of iron bis-glycinate chelate (IBC) in CD children with OIAT.

Establishment of a simple test for iron absorption from the gastrointestinal tract

Recent studies on iron metabolism have begun to reveal the molecular mechanisms underlying iron absorption, which is dramatically affected in several disorders. In the clinical setting, the ability to determine the status of iron absorption would aid in the diagnosis of pathological conditions. Efforts to develop an oral iron absorption test (OIAT) date back to at least 60 years. However, previous procedures were associated with a number of problems, such as radiation exposure and low reproducibility. In an attempt to resolve these issues, we employed sodium ferrous citrate (SFC), by which the influence of various nutrients and drugs on iron absorption was markedly reduced. We found that OIAT using SFC was simple to perform in both hospitalized patients and outpatients. The increment of serum iron and % transferrin saturation at 120 min after SFC administration was useful in distinguishing iron absorption between healthy volunteers, patients with iron-deficiency anemia, and patients with anemia secondary to chronic disorders, which are respectively characterized by normal, enhanced, and reduced iron absorption. Thus, the SFC-based OIAT may represent a viable screening test for the evaluation of gastrointestinal iron absorption.

Intravenous Iron Sucrose for Children with Iron Deficiency and/or Gastrointestinal Hemorrhage.

Abstract 2006Poster Board I-1028 Introduction:For decades parenteral iron has been used in patients with iron deficiency unresponsive to oral iron therapy and in hemodialysis-dependent patients receiving erythropoietin therapy. Iron dextran, used extensively in the past, is associated with a high rate of serious anaphylactic reactions and thus its use in children has been very limited. Intravenous (IV) iron sucrose (Venofer®) was approved by the FDA in 2000 for patients with chronic renal disease receiving erythropoietin therapy. Its safety profile being much more favorable than that of iron dextran, it has generally replaced iron dextran for use in both adults and children with chronic kidney disease. However, the use of iron sucrose for other indications in children has not to our knowledge been widely reported. Therefore, we sought to review our institution's quite favorable experience with IV iron sucrose in children without chronic renal disease. Methods:Pharmacy records were reviewed on all children (≤ 18 yrs of age) who received IV iron sucrose at Children's Medical Center Dallas between January 1, 2004 and June 30, 2009. Patients who received iron sucrose for chronic renal disease were excluded from analysis, and complete medical records were reviewed for patients receiving iron sucrose for all other indications. Data abstracted included primary indication for iron sucrose, underlying diagnoses, prior iron therapy, laboratory values before and after therapy, and adverse reactions. Results:157 children received at least one dose of IV iron sucrose during this period. 116 patients with chronic kidney disease were excluded as well as 3 patients with insufficient medical records. The remaining 38 patients who received iron sucrose for other indications were analyzed. Thirteen patients received IV iron sucrose due to iron deficiency refractory to oral iron therapy, 13 for primary iron malabsorption or dependence on parenteral nutrition, 7 for chronic gastrointestinal blood loss, and 5 for miscellaneous indications. The table shows the response in each group to both oral iron preparations and IV iron sucrose.Primary indication for IV iron sucrosenMean hgb rise after oral iron (g/dl)*Mean hgb rise after IV iron sucrose (g/dl)Refractory to oral iron130.033.5Malabsorption131.11.8Chronic blood loss71.52.9Other51.11.7*Oral iron therapy not previously administered to 7 ptsThe age of patients when they received IV iron sucrose ranged from 3 months to 18 yrs (median 5 yrs). The number of doses ranged from 1 to 255 (mean 13, median 3). The individual doses of IV iron sucrose ranged from 25mg to 500mg (median 100mg). All doses were diluted in a maximum of 250mL of normal saline and given over 15 minutes to 3.5 hours, depending on the dose and patient weight. The wide variety of doses and schedules employed reflected physician choice and lack of clear guidelines in the package insert. In the 38 children, who received a total of 510 doses of iron sucrose, there were only 6 adverse reactions attributed to the infusions. Five were mild (including headache, stomach irritation, transient mild hypotension and vasovagal reaction). One serious reaction occurred in an adolescent who received a large dose of 500 mg iron sucrose diluted in 250mL of normal saline over 35 minutes. The patient developed anxiety, face swelling, thready pulse, and hypotension. She promptly recovered following epinephrine, diphenyhydramine and methylprednisolone. Conclusions:IV iron sucrose is a safe and effective means to treat iron deficiency in children who 1) do not respond to oral iron due to intolerance or poor compliance, 2) cannot absorb oral iron due to a variety of congenital or acquired gastrointestinal disorders, and 3) who have ongoing blood loss making oral supplementation ineffective. An oral iron absorption test might help determine which patients are candidates for iron sucrose or another intravenous iron preparation. Prospective study of IV iron sucrose using standardized dosage guidelines are indicated in children and adults to confirm and extend these results. Disclosures:Off Label Use:Iron Sucrose for iron deficiency in children.

Ferrus Calcium Citrate Is Absorbed Better Than Iron Bisglycinate in Patients with Crohn's Disease, but Not in Healthy Controls

Our purpose was to compare the absorption of iron bisglycinate and ferrous calcium citrate in volunteers using an oral iron tolerance test. Twenty volunteers, 10 healthy controls and 10 with stable Crohn's disease, agreed to participate in the study. All were given 50 mg of elemental iron as iron bisglycinate or ferrous calcium citrate. Serum iron levels were monitored for 4 hr. After a week, each received the other regimen. Using the area under the curve as indicator, the oral iron absorption test revealed that absorption of iron post-ingestion of ferrous calcium citrate was better than after ingestion of iron bisglycinate for the group as a whole (P < 0.03). Volunteers with Crohn's disease absorbed ferrous calcium citrate better than iron bisglycinate (P=0.005). No difference was noted in the absorption of either preparation by healthy volunteers. Ferrus calcium citrate is apparently more effective than iron bisglycinate in patients with Crohn's disease.

P0726 IMPAIRED INTESTINAL IRON ABSORPTION IN CROHN???S DISEASE CORRELATES WITH DISEASE ACTIVITY AND INFLAMMATORY CYTOKINES

Introduction: The anemia of chronic inflammation in Crohn’s disease (CD) is multifactorial, and may be secondary to defective intestinal iron absorption, impaired iron delivery to erythroid precursors, impaired iron release from macrophages, and impaired erythropoietin production. The oral iron absorption test is a simple, minimally invasive method to establish whether oral iron can be absorbed by patients with iron deficiency and inflammatory states. In this study, we have evaluated this test in patients with CD, and correlated iron absorption with disease activity and with markers of systemic inflammation. Methods: Seventeen patients with CD (F=6,M=11) were recruited for this study. The patients were on a combination of medications, including: 5-ASA (N=7), corticosteroids (N= 7), and 6-mercaptopurine/azathioprine (N= 8) and infliximab (N=4). Of the 17 patients, 5 had active CD, as defined by a Pediatric Crohn’s Disease Activity Index (PCDAI) of >30 points. Twelve patients had inactive/mild CD (PCDAI<=30). Patients were admitted to the Children’s Hospital General Clinical Research Center after an overnight fast, and indwelling IV access was established. Baseline bloodwork obtained prior to the study included complete blood count, erythrocyte sedimentation rate, C-reactive protein, serum iron, TIBC, Ferritin, interleukins 1 and 6, and tumor necrosis factor. Oral Ferrous sulfate (1mg/ kg of elemental iron) was then administered. Iron levels were drawn at 1, 2, 3, and 4 hours after the administration of oral iron. The area under the curve (AUC) for iron absorption was calculated as the sum of the areas under the trapezoids formed between time points of serum iron levels. Results: Patients with active CD had markedly impaired iron absorption (mean AUC 154, compared to mean AUC 501 in inactive/mild). Iron absorption (AUC) correlated inversely with PCDAI and IL-6 (Spearman rho = −0.52, p= 0.03), (Table).Table 1: Iron Challenge Test and Inflammatory Markers in Active and Inactive CDConclusion: The oral iron challenge test is a simple method of determining an individual’s ability to absorb supplemental iron. Impaired intestinal iron absorption in CD is a function of disease activity.

Helicobacter pylori impairs iron absorption in infected individuals

Background. Infection with Helicobacter pylori is recognised as a major risk factor for chronic gastritis, peptic ulcer disease and gastric cancer. The association between H. pylori infection and iron deficiency anaemia has been established. Multiple mechanisms have been advocated to explain the relationship between H. pylori and iron status and their association might reduce iron deposit. Aim. Aim of this study was to investigate whether H. pylori infection affects iron absorption. Methods. The study was designed on a prospective basis. Fifty-five subjects underwent upper gastrointestinal endoscopy and biopsy to investigate the presence of H. pylori and, when this was positive, also search of serum anti-CagA was performed. Tests included an oral iron absorption test with the administration of 1 mg/kg of Fe 2+. Iron levels were measured before and 2 h after iron administration (delta iron). H. pylori-positive subjects were administered antibiotic therapy for 1 week and, 2 months later, the oral iron absorption test was repeated and urea-breath test was first performed. Results. H. pylori-positive subjects had lower serum level of ferritin and lower delta iron compared to H. pylori-negative subjects. That difference is significant in anaemic women and is independent of the presence of serum anti-CagA antibodies. After H. pylori eradication iron absorption test was similar to those of non-infected subjects. Conclusion. H. pylori infection impairs iron uptake. That mechanism, together with others, may contribute to the depletion of iron in infected patients.

Helicobacter pylori impairs iron absorption in infected individuals

Background. Infection with Helicobacter pylori is recognised as a major risk factor for chronic gastritis, peptic ulcer disease and gastric cancer. The association between H. pylori infection and iron deficiency anaemia has been established. Multiple mechanisms have been advocated to explain the relationship between H. pylori and iron status and their association might reduce iron deposit. Aim. Aim of this study was to investigate whether H. pylori infection affects iron absorption. Methods. The study was designed on a prospective basis. Fifty-five subjects underwent upper gastrointestinal endoscopy and biopsy to investigate the presence of H. pylori and, when this was positive, also search of serum anti-CagA was performed. Tests included an oral iron absorption test with the administration of 1 mg/kg of Fe2+. Iron levels were measured before and 2 h after iron administration (delta iron). H. pylori-positive subjects were administered antibiotic therapy for 1 week and, 2 months later, the oral iron absorption test was repeated and urea-breath test was first performed. Results. H. pylori-positive subjects had lower serum level of ferritin and lower delta iron compared to H. pylori-negative subjects. That difference is significant in anaemic women and is independent of the presence of serum anti-CagA antibodies. After H. pylori eradication iron absorption test was similar to those of non-infected subjects. Conclusion. H. pylori infection impairs iron uptake. That mechanism, together with others, may contribute to the depletion of iron in infected patients.

Oral iron absorption test: should it be performed before starting treatment with ferrous preparations?

The oral iron absorption test is sometimes used in the assessment of ferrous preparation efficacy before therapeutic use in the treatment of patients with anemia. Overdoses of Fe can cause the production of free radicals that are dangerous because of chemical modifications and damage of proteins, lipids, carbohydrates, and nucleotides. We suggest that this test should not be performed with the recommended dose of iron because of the potential threat to the patients. We assessed the serum concentration of iron and total iron-binding capacity during the test. Before and after the test, the concentration of malonyldialdehyde, an end product of lipid peroxidation, was determined in serum. In most patients, we found an increase in malonyldialdehyde concentration, suggesting the enhanced production of free radicals. This increase was particularly marked in patients with an overabsorption of iron. The administration of iron in the dose recommended for the oral iron absorption test causes increase in serum malonyldialdehyde concentration, proving an overproduction of free radicals. This test should not be performed because of the evidence proving detrimental effects of free-radical overproduction on the human body.