From the Research
The most likely cause of a gastric ulcer with pathology showing brownish crystals in a fish scale pattern is iron pill-induced gastritis, also known as iron pill gastropathy. This condition occurs when oral iron supplements directly damage the gastric mucosa through direct corrosive effects. The characteristic "fish scale" pattern represents iron deposits in the gastric mucosa, which appear as brownish crystals under microscopic examination. Patients taking ferrous sulfate, ferrous fumarate, or other oral iron preparations are at risk, particularly when taking higher doses or when pills are retained in the stomach for prolonged periods. Management typically involves discontinuing the oral iron preparation or switching to a different formulation such as liquid iron, enteric-coated tablets, or parenteral iron if supplementation is still needed. Proton pump inhibitors like omeprazole 20-40mg daily may be prescribed to promote healing of the gastric mucosa, as supported by studies on the use of proton-pump inhibitors in complicated ulcer disease and upper gastrointestinal tract bleeding 1. The condition is reversible once the iron supplementation is modified or discontinued, with complete resolution of the mucosal injury typically occurring within weeks to months.
Key points to consider in the management of iron pill-induced gastritis include:
- Discontinuing the oral iron preparation or switching to a different formulation
- Prescribing proton pump inhibitors to promote healing of the gastric mucosa
- Monitoring for complete resolution of the mucosal injury
- Considering alternative iron supplementation formulations, such as liquid iron or parenteral iron, if necessary
It is essential to note that the provided evidence does not directly address the specific condition of iron pill-induced gastritis, but the characteristic "fish scale" pattern and the association with oral iron supplements support this diagnosis. Studies on the pharmacotherapy for peptic ulcer disease 2 and the use of proton-pump inhibitors in complicated ulcer disease and upper gastrointestinal tract bleeding 1 provide relevant information on the management of gastric ulcers, but the most recent and highest-quality study on this specific topic is not available in the provided evidence. However, based on the available information and general medical knowledge, iron pill-induced gastritis is the most likely cause of a gastric ulcer with pathology showing brownish crystals in a fish scale pattern.