Symptoms Of Iron Deficiency Anemia Research Articles

Combined Iron Deficiency Anemia and Occult Seronegative Gluten Intolerance

A 66-year old man with new symptomatic iron deficiency anemia was investigated with gastroscopy, which revealed adenomatous large inflammatory erosive polyp, which was removed. Iron reach diet and iron replacement therapy was only partially helpful but serum iron indicators were still reduced. Abnormal iron absorption was proposed. Celiac transaminase tTG- IGA and anti-gliadin and anti-endomysial antibodies were negative. Due to suspicion of seronegative gluten intolerance gluten free diet was initiated. Hemoglobin and serum iron characteristics became normal two months later. We conclude: occult iron deficiency reasons should not be missed including seronegative gluten intolerance.

Iron Deficiency Anemia among School Going Children of Rural Area of Mardan Khyber Pakhtunkhwa

Iron is essential for normal human growth, including oxygen transport, adenosine triphosphate (ATP) production, DNA synthesis, mitochondrial function, and protection of cells from oxidative damage. Iron deficiency anemia is the most prevalent hematologic disorder in school-going children. Therefore the aims were the study to assess the prevalence of anemia among school-going children of rural areas of Mardan Khyber Pakhtunkhwa. A total of 300 samples were taken from those children of signs and symptoms of Iron deficiency Anemia cross-section survey. Thorough physical Examination, Lab investigations, and Clinical examination. The current research work shows that 1 of 3rd of the school-going children who had signs and symptoms of iron deficiency anemia were affected with iron deficiency Anemia at the ages of 4 to 7 years 40(40%), 7 to 10 years 35(35%) and 10 to 13 years 25(25%) respectively. severe anemia was rare at 10%, moderate anemia at 25% led by the mild type of anemia with a high percentage of 65% on the basis of Hb level. lower class families were more affected by iron deficiency anemia with 60%, children of middle class were less affected by anemia with 35% while children of upper class families were much less affected by anemia which may be due to the socioeconomic state of the family. Therefore it is recommended that iron supplementation and health and nutrition education programs should be strengthened.

Pica sebagai Manifestasi Anemia Defisiensi Besi: Suatu Laporan Kasus

Prevalence of anemia in Indonesia based on Basic Health Research (2018) was 23.7%. Symptoms of iron deficiency anemia were pallor, malaise, palpitation, shortness of breath, headache, sore tongue. But sometimes can be found abnormal behavior in the form of PICA. This article reports on a-52-year-old man who sought medical treatment and was diagnosed with iron deficiency anemia with pica manifestation. The pica manifestation was characterized by a repeated desire to consume raw rice due to bleeding from hemorrhoids. Patient was given oral iron replacement therapy contain 100 mg of Fe (III) hydroxide polymaltose complex and folic acid 0.35 mg alternating with vitamin C 500 mg daily. Total iron daily dose given were 200 mg, divided in two doses. The patient received dietary education and was advised to consult a Gastroenterohepatology Subspecialist for the management of hemorrhoids, but it has not been done yet. The desire for raw rice consumption disappeared and the hemoglobin level increased to 12.4 g/dL after six weeks of therapy. The patient continued to take iron supplements until January 2023 but did not have follow-up visits to the clinic. In January 2023, the patient underwent hemorrhoid surgery due to bleeding accompanied by and a non-reducible lump that had been present for three days. Iron supplements continued for one month post-operation and then discontinued. The latest hemoglobin level was 15.3 g/dL without iron supplements. The symptoms of pica in this patient disappeared along with an increased hemoglobin level, and the management of severe anemia in this patient showed an adequate response. Bleeding has never occurred again after the surgery. Curative measures for hemorrhoidal bleeding are crucial, while iron supplementation is only a supportive therapy.

Unusual symptoms of iron deficiency anemia (2 clinical observations)

Iron deficiency is a leading cause of anemia, the most common malnutrition worldwide, affecting 42% of children worldwide. Most often, iron deficiency occurs in children of the first year of life and adolescents; its prevalence in adolescents has pronounced gender differences. In Russia, it is much more common in girls in 17.231.0% of cases, which is 1.6 times higher than in boys. The presence of delayed adverse effects of iron deficiency at an early age has been established, therefore, timely correction of sideropenic conditions in young children is important for the prevention of long-term consequences of a childs development. The article presents two clinical cases of iron deficiency anemia in adolescent girls who had iron deficiency in the first year of life. On the example of the first clinical observation, we observe the development of alopecia against the background of severe sideropenia as part of the epithelial syndrome with iron deficiency anemia of moderate severity. Iron deficiency in this case is multifactorial maternal anemia during pregnancy, spontaneous subarachnoid hemorrhage, shunt infection, and uncorrected iron deficiency in the first two years. The second clinical example illustrates iron deficiency anemia of mixed genesis in a teenage girl, which was the result of insufficient iron stores at birth, alimentary insufficiency, aggravated against the background of heavy, prolonged menstruation. In this case, there is no hair loss, despite the more severe course of anemia, a long refractory period with iron therapy. The data of clinical cases confirm the significance of low iron stores at birth in the risk of developing iron deficiency anemia in puberty. During the examination of children, the need to take into account the state of the gastrointestinal tract in the algorithm for diagnosing the state of the gastrointestinal tract (detection of malabsorption, blood loss) was shown.

Effectiveness of Dietary Intervention on Iron Deficiency Anemia among Adolescent Girls from selected rural area in Dharapuram

Adolescent years are a time of increased growth that is accompanied by increase in appetite and nutritional requirements. Accelerated growth and poor eating habits make the adolescent at risk for poor nutritional health. A study was aimed to evaluate the effectiveness of dietary interventions on iron deficiency anemia among adolescent girls from selected rural areas in Dharapuram. Evaluative approach was used for this study. Pre experimental one group pretest and post-test design was adopted to conduct the study. Conceptual frame work used for the study was revised penders health promotion model (2002). 60 Adolescent girls with hemoglobin level of below 11gm/dl were selected as samples by using Non probability purposive sampling technique. The demographic variables of selected samples were assessed by self-administered questionnaire. The signs and symptoms of iron deficiency anemia was assessed by using observational checklist and the level of hemoglobin was assessed by Sahli’s hemoglobinmeter. Dietary intervention of sweet rice flake ball (50gm) and one gooseberry was given for 30 days, made the samples to consume in front of the researcher. After 30 days of dietary intervention post-test level of hemoglobin and the signs and symptoms were assessed. The data were analyzed by using descriptive and inferential statistics. The study findings revealed that in pretest 53(88.3%) had the signs and symptoms at mild level, 7(11.7%) had moderate level. In post-test 59(98.3%) had signs and symptoms at mild level, 1(1.7%) had moderate level of signs and symptoms among adolescent girls with iron deficiency anemia. The study results revealed that the mean score of pretest and post-test level of hemoglobin among adolescent girls were 8.95(SD±1.13) and 11.24(SD±1.54) respectively. The mean difference was 2.29. The paired ‘t’ value was 13.5. Which was significant at P<0.05 level. Chi - Squre test revealed that the demographic variables like Age (χ2 = 11.29), number of children in the family (χ2 = 20.89) Food habits (χ2 = 10.43), number of days of menstruation (χ2 = 15.62), habit of foot wear while going out (χ2 = 24.12) had significant association with post-test level of hemoglobin among adolescent girls at P<0.05 level. The study concluded that the dietary intervention of sweet rice flake and one gooseberry plays an important role in the improvement of hemoglobin among adolescent girls.

Oral Health - A Mirror of Plummer Vinson Syndrome

A lack of significant iron in the normal red blood cells leads to iron deficiency anaemia (IDA). Plummer Vinson Syndrome (PVS) is a syndrome with the clinical triad of symptoms of iron deficiency anaemia, dysphagia and oesophageal webs. Repeated injury to epithelia due to iron deficiency leads to atrophy of mucosa and degradation of pharyngeal muscles, leading to the development of oesophageal webs. Oral manifestations are the initial symptoms and oral cavity is the mirror of the systemic conditions of the body. Henceforth dentists play a major role in promptly diagnosing the oral health of an individual. Under this background, we present a case of Plummer Vinson Syndrome with oral manifestations. Keywords: Anaemia, Iron deficiency, Plummer Vinson Syndrome, Haemoglobin, Dysphagia, Oesophageal webs, Endoscopy, Oral Health.

Malignant Glomus Tumor of the Gastric Antrum with Liver Metastasis in a 35-year-old Female: A Case Report

Glomus tumors (GTs) are mesenchymal tumors derived from modified smooth muscle cells of the glomus body. These tumors account for less than 2% of all soft tissue tumors, and of those less than 1% are malignant. A 35-year-old African American female presented with symptomatic iron deficiency anemia. On esophagogastroduodenoscopy, a 5 cm mass was seen partially obstructing the antrum and tissue biopsy was obtained. The biopsy showed low-grade epithelial mesenchymal neoplasm with features of a glomus tumor. A follow up computed tomography (CT) chest/abdomen/pelvis revealed a 5 cm relatively homogeneous solid mass in the gastric antrum, which appeared most similar to a gastrointestinal stromal tumor. During the planned distal gastrectomy with reconstruction, one hepatic metastasis was identified via intraoperative ultrasound and was confirmed by frozen section consultation to be the same histologic type as the antral mass. Pathologic and immunohistochemical findings were consistent with a malignant gastric glomus tumor with liver metastasis. Most GTs have a benign clinical course making the diagnosis and treatment of malignant GTs an ongoing challenge. The data on glomus tumors of the viscera is limited by the rarity of these tumors, with most of the known presentation and treatment gathered from case reports.

Potential impact of sirolimus on gastric polyposis burden in juvenile polyposis syndrome

A 32-year-old man with SMAD4 (c.1152delTC)—associated juvenile polyposis and hereditary hemorrhagic telangiectasia overlap syndrome experienced symptomatic iron deficiency anemia in 2017 from bleeding gastric polyposis requiring blood transfusions and intravenous iron therapy every 6 months. The patient was referred to our center for further treatment. EGD demonstrated massive gastric polyposis from the pylorus to the incisura, including many ulcerated, friable polyps, which bled on contact (A, left).

Laparoscopic resection of a pediatric intestinal leiomyosarcoma

Intestinal leiomyosarcomas represent an exceptionally rare tumour in children. We report a 15-year-old female who presented with a long history of symptomatic iron deficiency anemia. Multiple investigations failed to lead to a diagnosis, however, a small bowel video capsule endoscopy demonstrated an ileal polyp. She proceeded to surgery where an ileo-ileal intussusception was found and underwent a small bowel resection. Histopathology confirmed a well-differentiated leiomyosarcoma that stained positive for smooth muscle actin and negative for c-kit, differentiating it from a gastrointestinal stromal tumour (GIST). This case becomes only the fourth reported case in the 21st century. The authors explore the current literature on this tumour in the pediatric population and how in the last two decades the discovery of specific immunohistochemistry staining resulted in most intestinal leiomyosarcoma being classified correctly as GISTs.

S3592 Cameron Lesions Resulting in Occult GI Bleeding and Anemia

Introduction: Cameron lesions are ulcerations which develop in the sac of hiatal hernias at the diaphragmatic hiatus. They occur in about 3-12% of patients with hiatal hernias. The overall prevalence of Cameron lesions in all patients is less than 1%. Nonsteroidal anti-inflammatory drugs (NSAIDs) are also associated with the development of Cameron lesions. These lesions can present with either occult or overt gastrointestinal bleeding. They are often missed on routine endoscopy given their diminutive size and inconspicuous location which requires thorough antegrade and retrograde examination. We describe a case of a woman with a large hiatal hernia and Cameron lesions with resulting symptomatic iron deficiency anemia. Case Description/Methods: A 50-year-old woman with obstructive sleep apnea, chronic lymphedema, and major depressive disorder underwent routine esophagogastroduodenoscopy (EGD) due to several months of dysphagia and odynophagia. She was found to have grade B esophagitis and a large hiatal hernia with multiple Cameron lesions. Proton pump inhibitor was prescribed. A few months later, patient presented to clinic with orthostatic dizziness and weakness; Hemoglobin (Hgb) was 6.0 mg/dL (previously normal two years prior). She was admitted to the hospital and received red blood cell transfusions with an appropriate response in Hgb and oral iron supplementation; anti-reflux medications were continued on discharge. After one year of strict adherence to anti-reflux regimen and iron supplementation, her hemoglobin levels normalized. Repeat EGD was obtained eighteen months later due to continued dysphagia and odynophagia and showed resolution of Cameron lesions and esophagitis but progression in the size of the hiatal hernia. She was referred to a general surgeon and underwent laparascopic para-esophageal repair and partial fundoplication with resolution of her symptoms. Discussion: Cameron lesions may cause overt and occult gastrointestinal bleeding with resulting iron deficiency anemia. These lesions have been mostly described in association with large hiatal hernias and routine NSAID use. Medical treatment with a proton pump inhibitor and discontinuation of NSAIDs is usually sufficient to treat these ulcerations but some patients may require endoscopic or surgical management in severe cases. Gastroenterologists should give special attention to the mucosa of the diaphragmatic hiatus in patients with a hiatal hernia and suspicion for gastrointestinal bleeding to evaluate for Cameron lesions.Figure 1.: Cameron lesions seen on retrograde view during endoscopy.

Prosthetic Rehabilitation of a Patient with Symptoms of Iron Deficiency Anaemia in association with Fraser’s Syndrome – A Case Report

About a quarter of the population in the world is affected with Anaemia and deficiency of iron is one ofthe major causes. Associated symptoms are long term fatigue, cognitive function which shows impairment,and decreased well-being. “Fraser syndrome” can be described as rare, genetically inherited disorder. It ismanifested as Crytophthalmos, Syndactyly along with Enamel Hypoplasia because of which the patient isreferred to a dentist. The following report presents the report of a male patient who had symptoms of irondeficiency anaemia and also showed signs & symptoms of Fraser’s Syndrome. Proper knowledge regardingFraser’s syndrome and iron deficiency anaemia is imperative to plan an oral rehabilitation treatment protocolfor such patients.

Structural basis of ion transport and inhibition in ferroportin

Ferroportin is an iron exporter essential for releasing cellular iron into circulation. Ferroportin is inhibited by a peptide hormone, hepcidin. In humans, mutations in ferroportin lead to ferroportin diseases that are often associated with accumulation of iron in macrophages and symptoms of iron deficiency anemia. Here we present the structures of the ferroportin from the primate Philippine tarsier (TsFpn) in the presence and absence of hepcidin solved by cryo-electron microscopy. TsFpn is composed of two domains resembling a clamshell and the structure defines two metal ion binding sites, one in each domain. Both structures are in an outward-facing conformation, and hepcidin binds between the two domains and reaches one of the ion binding sites. Functional studies show that TsFpn is an electroneutral H+/Fe2+ antiporter so that transport of each Fe2+ is coupled to transport of two H+ in the opposite direction. Perturbing either of the ion binding sites compromises the coupled transport of H+ and Fe2+. These results establish the structural basis of metal ion binding, transport and inhibition in ferroportin and provide a blueprint for targeting ferroportin in pharmacological intervention of ferroportin diseases.

S2915 Endoscopic Retrieval of Retained Video Capsule in Small Intestine Obscure Occult Gastrointestinal Bleeding

INTRODUCTION: Despite significant symptoms of iron deficiency anemia, subtle and ominous luminal pathology may be missed in the small intestine on both dedicated cross-sectional imaging and conventional endoscopic evaluation. In such cases, video capsule endoscopy may prove invaluable - although not without risk. CASE DESCRIPTION/METHODS: A 56-year-old man developed recurrent, symptomatic transfusion-dependent iron deficiency anemia and fecal occult positive stool despite no overt gastrointestinal bleeding. He had undergone subtotal colectomy with ileorectal anastomosis three years earlier for colorectal cancer and was on hemodialysis for end-stage renal failure. Recent negative evaluation included esophagogastroduodenoscopy, ileo-colonoscopy, computed tomogram enteroclysis, and push enteroscopy to the distal duodenum. Informed consent was obtained for video capsule endoscopy (VCE), including risk counseling for capsule retention. VCE showed fresh blood and recurring views of an ulcerated nodular lesion on multiple frames (Figure A, blue arrow) twenty hours into recording. The patient had no signs and symptoms of bowel obstruction. However, abdominal x-ray on two consecutive days revealed no change in capsule location in the left upper quadrant (Figure B). Repeat push enteroscopy identified the retained capsule in the proximal jejunum and a partially obstructing circumferential tumor distal to it (Figure C). The capsule was retrieved with a Roth net and the site was tattooed. Histology showed moderately differentiated adenocarcinoma. The jejunal tumor was removed surgically. DISCUSSION: This case illustrates a presentation of obscure occult gastrointestinal bleeding secondary to small bowel adenocarcinoma diagnosed by retained video capsule endoscopy. While the risk of capsule retention is low, informed consent regarding this risk is paramount. Once the capsule is retained, definitive curative resection of the affected small bowel section is almost mandatory irrespective of pathology. Retrieval of retained capsules in patients without clinical small bowel obstruction may be feasible endoscopically. Simultaneous endoscopic examination of the partially obstructed site can further facilitate diagnosis and location marking prior to surgery. Simple, cheap and readily available investigations such as serial abdominal x-rays can have an adjunct role in putting the pieces together to solve a seemingly complex diagnostic puzzle.Figure 1.: Figure A: Ulcerated nodular lesion (red arrow) in the small bowel on persistent views on video capsule endoscopy several hours into recording.Figure 2.: Figure B: Abdominal x-ray showing unchanged video capsule location (red arrow) in the left upper quadrant.Figure 3.: Figure C: Endoscopic view of retained video capsule (red arrow) in the proximal jejunum and a partially obstructing tumor distal to it (blue arrow).

S2223 Dead End in the Small Bowel: Rare Case of Small Bowel Melanoma Presenting as Melena

INTRODUCTION: Malignant melanoma accounts for only 1% of all malignant tumors of the small bowel. The majority are usually metastatic from the skin eye or anorectum. Less than 50 cases of truly primary small bowel melanomas have been described in literature with overt bleeding as a presenting complaint even rarer. We present such a case of an elderly man with middle gastrointestinal bleeding who was found to have unresectable small bowel melanoma on device assisted enteroscopy. CASE DESCRIPTION/METHODS: An 80-year-old man with stage IV Chronic kidney disease presented to the hospital with a few months of dark tarry stools and symptomatic iron deficiency anemia refractory to iron supplementation needing up to 7 transfusions. He did not endorse Non-steroidal anti-inflammatory drug use. An esophagoduodenoscopy and colonoscopy at an outside facility was unremarkable. Video capsule endoscopy showed hematin in the the proximal jejunum with a possible ulcer more distally. A single balloon enteroscopy revealed a 10 mm cratered jejunal ulcer with slight pigmentation in the base (Figure 1). This was biopsied. Pathology revealed malignant melanoma with BRAF V600E mutation. Subsequent positron emission tomography (PET) showed a 6 cm small bowel mass compatible with primary site and metastatic lesions in the mesentery, perihepatic and subdiaphragmatic region (Figure 2). Following tumor board discussion, he was referred for palliative radiotherapy. DISCUSSION: Primary mucosal melanoma most commonly arises from the anal canal (31.4%), rectum (22.2%) and oropharynx (33%). Only 2.3% of cases have been reported from the small bowel. Presence of melanocytes has not yet been demonstrated in the small intestine, and the origin of primary melanoma of the small intestine remains unknown. Blecker et al. suggested a strict criteria for the diagnosis of primary intestinal melanoma: no evidence of concurrent cutaneous lesions, absence of extraintestinal metastatic spread of melanoma, and presence of intramucosal lesions in the overlying intestinal epithelium. This form of melanoma is more aggressive and associated with worse prognosis. Other factors of poor prognosis include lymph node involvement, advanced age and failure to undertake surgical resection (which remains the primary treatment option). Our case highlights the importance of keeping a broad differential in patients presenting with middle GI bleeding and aggressively pursuing tissue diagnosis in such cases.Figure 1.: Proximal Jejunum ulcer.Figure 2.: PET scan image with metastatic melanoma.

Plummer-Vinson syndrome: A decade's experience of 132 cases from a single center.

Plummer-Vinson syndrome (PVS) comprises triad of iron deficiency anemia, dysphagia, and post-cricoid esophageal web. PVS is rare nowadays due to improved nutritional status. However, we encountered patients with PVS regularly at our center. Data regarding PVS are limited; hence, we aimed to study the clinical features, treatment outcomes, and development of complications in patients with PVS. The study was conducted over a 10-year period (January 2008 to January 2018) in a medical college setting. All adults with dysphagia, anemia, and post-cricoid web or those with iron deficiency anemia and post-cricoids web were included in the study. Patients were treated with iron supplementation and Savary-Gilliard bougie dilation of the web. Patients were followed-up for the recurrence of dysphagia and development of complications. Overall, 153 patients exhibited esophageal web, of which 132 (86.27%) patients had concomitant PVS and 21 (13.7%) patients did not. The mean age was 43.50years (range 16-76) and 113 (85.6%) were women. Single session of Savary-Gilliard bougie dilation was successful in 90.7% of patients in relieving dysphagia and 9.3% developed recurrence, requiring repeated dilations. Four patients had concomitant squamous cell carcinoma of esophagus along with PVS and two developed upper gastrointestinal malignancy during follow-up. Plummer-Vinson syndrome is predominantly seen in middle aged women and present with symptoms of iron deficiency anemia and early grade dysphagia. Single session of Savary-Gilliard bougie dilation was successful in majority of patients in relieving dysphagia. Overall risk of developing upper gastrointestinal malignancy was 4.5%.

Discrimination of β-thalassemia and iron deficiency anemia through extreme learning machine and regularized extreme learning machine based decision support system

The symptoms of Iron Deficiency Anemia (IDA) and β-thalassemia (β-TT) disease are similar and the distinction between them is time consuming and costly. There are several indices used to differentiate IDA from β-thalassemia disease. Complete Blood Count (CBC) is a rapid, inexpensive and accessible test for the diagnosis of anemia and is used as a primary test. However, since CBC cannot fully distinguish between IDA and β-thalassemia, more advanced testing is required. These tests are not available in small centers and are performed on higher-cost devices. Moreover, it is important to differentiate between anemia and β-thalassemia medically for two reasons (IDA). First, if a patient with β-Thalassemia is diagnosed with IDA, the patient is given unnecessary iron supplementation as a result of the treatment, which is recommended by the doctor. Secondly, when the patient with β-thalassemia is diagnosed with IDA, children will have β-thalassemia patients in marriages. A decision support system to distinguish between β-Thalassemia and IDA has been developed. Logistic Regression, K-Nearest Neighbours, Support Vector Machine, Extreme Learning Machine and Regularized Extreme Learning Machine classification algorithms were used in the proposed system. Classification performance was evaluated with Accuracy, sensitivity, f-measure, Specificty parameters using Hemoglobin, RBC, HCT, MCV, MCH, MCHC and RDW parameters obtained from 342 patients. 96.30% accuracy for female, 94.37% for male, and 95.59% in co-evaluation of male and female patients were obtained.

Clinical and biochemical profile of patients with Iron deficiency anemia at a tertiary care hospital

Introduction: Iron deficiency anemia (IDA) is the most common cause of anemia worldwide, especially in adolescent girls, women of reproductive age group, and young children. The clinical presentation and the other biochemical parameters differ in a different age, sex, and geographical group. A study to evaluate the clinical and biochemical profile of patients with IDA at a tertiary care hospital. Materials and Methods: One hundred and two Cases of IDA were taken from the outpatient department (OPD) and ward. After taking consent, the workup was done. Complete history and physical examination were done, and patients were evaluated for signs and symptoms of IDA. Laboratory investigations such as complete blood count with differential count, reticulocyte count, peripheral blood smears, serum iron, total iron binding capacity, serum ferritin, lactic dehydrogenase, stool for occult blood and ova, cysts, liver and renal function were done in all the patients. Results: One hundred and two patients of IDA were enrolled from OPD and ward. The majority of the patients were from the 21 to 30 years age group (25.5%). 37.3% were male and 62.7% were female patients. The main presenting complaint was weakness and easy fatigability (91%). Among the associated comorbidities, the most common were hypertension (13.7%). The majority of the patients had severe pallor (54.9%). Icterus was found in 1.9%. Splenomegaly was found in 4.9%. General blood pictures showed 97.1% had microcytes, 96.1% had hypochromasia and 97.1% had Anisocytosis, which is characteristic of IDA. Conclusion: The majority of patients came to the hospital after developing clinical features due to severe anemia. Therefore, a population based study to evaluate the mild form of IDA or to evaluate a preanemic iron deficiency state can help in the early diagnosis of these patients before they develop severe form.

1972 Proton Pump Inhibitors Causing Severe Chronic GI Blood Loss Resulting in Severe Iron Deficiency Anemia

INTRODUCTION: Proton pump inhibitors (PPI) are a commonly used medication for the treatment for gastroesophageal reflux disease (GERD), peptic and NSAIDs induced ulcers. We report a rare case of severe chronic GI bleeding leading to severe iron deficiency anemia, caused by extensive hemorrhagic fundic gland gastric polyps secondary to long term PPI therapy. CASE DESCRIPTION/METHODS: A 77-year-old woman with past medical history of GERD controlled with omeprazole 20 mg daily, who was referred to GI due to severe symptomatic iron deficiency anemia. For about a year, her hemoglobin was slowly trending down, when she was referred to GI, her hemoglobin was 8.2 g/dl, with MCV 69 FL. Her iron indices showed iron saturation of 8%, TIBC of 426 mg/dl, and ferritin level of 8. She was started on oral iron therapy, and underwent colonoscopy and esophagogastroduodenoscopy (EGD) which revealed left colon diverticulosis, and innumerable gastric polyps including numerous large hemorrhagic polyps involving the entire stomach but excluding the antrum. Polypectomy of multiple polyps was done, although due to the extensive polyps burden, could not practically remove all polyps in one session. Pathology evaluation confirmed fundic glands polyps, with focal adenomatous changes in one of the large polyps without dysplasia, and there was no evidence of H.Pylori. Patient was advised to stop omeprazole, and was given ranitidine 150 mg BID as needed for reflux symptom. She had a second EGD one month later which still revealed innumerable gastric polyps, further removal of multiple large polyps was done, pathology was consistent with fundic glands polyps. 6 months later on follow up, patient hemoglobin improved to 12.3 mg/dl, with normalization of ferritin level. She had a repeat EGD which revealed remarkable regression of the size and number of the gastric polyps. DISCUSSION: We report herein a case of extensive gastric polyposis consistent with stent fundic glands polyps leading to severe chronic blood loss causing severe iron deficiency anemia. Fundic glands polyps in our patient, are attributed to hypergastrenemia secondary to chronic long term PPI administration.Most polyps are sporadic, hypergastrenemia due to ZES or chronic PPI use is associated with increase in prevalence of FGPs. A study showed fourfold increased risk of FGPs in patients on long term PPI therapy (over 5 years). Case reports have showed regression in number and size of FGPs after cessation of PPI therapy, as seen in our patient case.

2535 Localized AL-Type Intestinal Amyloidosis Presenting as Refractory Iron Deficiency Anemia and Right Lower Quadrant Abdominal Pain

INTRODUCTION: Amyloidosis is characterized by extracellular deposition of abnormally folded proteins creating insoluble fibrils, which disrupt tissue structure and function. Amyloidosis can be either systemic or localized. Localized amyloidosis is defined by the production of precursor proteins in the same location as amyloid deposition. We present a case of biopsy-proven localized AL intestinal amyloidosis. CASE DESCRIPTION/METHODS: A 91-year-old female with a past medical history significant for hypertension and iron deficiency anemia not improving with oral iron presented with progressively worsening dyspnea on minimal exertion, with diffuse weakness and fatigue. She denied any NSAID use. Hemoglobin on admission was 3.8 g/dL, improving to 6.4 g/dL after transfusion of 3 units of packed red blood cells. Upper endoscopy showed very friable mucosa with contact bleeding in the duodenum, along with patchy areas of abnormal mucosa in the 2nd portion (Figure 1). Duodenal biopsies were consistent with amyloidosis based on Congo red and crystal violet stains. Liquid chromatography tandem mass spectrometry was performed on peptides extracted from the specimen and indicated AL (lambda)-type amyloid deposition. Cardiac MRI showed no evidence of infiltrative heart disease or amyloid deposition. Bone survey showed no lytic lesion, and a marrow biopsy showed no morphologic evidence of plasma cell neoplasm with normal karyotype. Urine immunofixation electrophoresis showed no abnormalities. Urine and serum protein electrophoresis showed no monoclonal protein. With no evidence of systemic amyloidosis, diagnosis of localized intestinal amyloidosis was made. No systemic therapy was indicated. Patient was treated with IV iron transfusions. At a subsequent admission, she presented with subacute right lower quadrant pain. CT abdomen/pelvis with oral and intravenous contrast showed thickening of the distal small bowel with shouldering (Figure 2). Lesion was presumed to be secondary to intestinal amyloidosis. Patient refused further invasive interventions. DISCUSSION: Localized AL-type intestinal amyloidosis is rarely diagnosed. Common symptoms are non-specific and can include erosion, ulceration, bleeding, malabsorption, intractable diarrhea, obstruction or ischemia. This patient presented with recurrent symptomatic iron deficiency anemia refractory to oral iron repletion. Intestinal amyloidosis should be considered in similar presentations.

Endoscopic eradication of nodular gastric vascular antral ectasia by using band ligation after argon plasma coagulation

Gastric antral vascular ectasia (GAVE) is an important cause of gastro-intestinal bleeding. The most common clinical presentation of GAVE is chronic occult bleeding that leads to symptomatic iron deficiency anemia, but some cases could present with acute massive bleeding. Frequently, patients are dependent by iron suplimentation, or in severe cases even blood transfusions. Endoscopic therapy is frequently necessary in acute or chronic blood loss. Over the past several years, treatment for GAVE has continued to evolve as the number of available effective therapeutic interventions has increased. These included: YAG laser, argon plasma coagulation (APC), endoscopic band ligation, cryotherapy and surgical anterectomy. Argon plasma coagulation is the most commonly used technique, but has been associated with several complications like sepsis, post-APC bleeding, gastric outlet obstruction and increased incidence of hyperplastic polyps. Endoscopic band ligation (EBL), a mechanical procedure, has been reported in the past years as an effective salvage therapy for GAVE that is refractory to other approaches, or even as the first line treatment. We present a case of nodular GAVE treated succesfully with endoscopic band ligation after unsuccesufull sessions with argon plasma coagulation.