Can erosive gastritis cause anemia?

Erosive Gastritis as a Cause of Anemia

Yes, erosive gastritis can cause iron deficiency anemia through chronic blood loss from gastric mucosal erosions. 1, 2

Mechanism and Presentation

Erosive gastritis involves inflammation of the gastric mucosa with multiple superficial erosions that can lead to chronic, often occult blood loss. This blood loss can result in iron deficiency anemia through several mechanisms:

1. Direct blood loss: Erosions in the gastric mucosa allow for continuous, low-grade bleeding into the gastrointestinal tract 2
2. Impaired iron absorption: Inflammation of the gastric mucosa can reduce acid production necessary for optimal iron absorption 1

Diagnostic Approach

When evaluating anemia in the context of suspected erosive gastritis:

• Laboratory assessment: Complete blood count showing microcytic, hypochromic anemia with low ferritin levels (<30 μg/L) 1
• Upper endoscopy (EGD): The gold standard for diagnosis, allowing direct visualization of gastric erosions and collection of biopsies 1
• H. pylori testing: Should be performed in all patients with gastritis, as H. pylori infection can contribute to both gastritis and iron deficiency 3, 4

Common Etiologies of Erosive Gastritis Leading to Anemia

1. NSAID use: Regular use of non-steroidal anti-inflammatory drugs is a common cause of erosive gastritis 5
2. H. pylori infection: Can cause chronic gastritis with erosions and impair iron absorption 4
3. Alcohol consumption: Chronic alcohol use can lead to gastric mucosal damage
4. Physical stress: As demonstrated in the case of the female runner with exercise-induced erosive gastritis 2
5. Autoimmune gastritis: Can cause both gastric erosions and impaired vitamin B12/iron absorption 1, 6

Management Approach

1. Treat underlying cause:

   • Discontinue NSAIDs if possible
   • Eradicate H. pylori if present (triple therapy with PPI, amoxicillin, and clarithromycin for 14 days) 3
   • Acid suppression therapy with PPIs or H2-receptor antagonists 2

2. Iron replacement therapy:

   • Oral iron: Ferrous sulfate 200mg twice daily is first-line therapy 1
   • Lower doses may be better tolerated (consider 100mg daily if side effects occur) 1
   • Continue iron therapy for 3-6 months after hemoglobin normalizes to replenish iron stores 7

3. Follow-up:

   • Monitor hemoglobin and ferritin levels to ensure response to therapy
   • Consider repeat endoscopy to confirm healing of erosions in severe cases

Special Considerations

• Persistent or recurrent anemia: In patients with erosive gastritis and persistent anemia despite treatment, consider additional GI evaluation including colonoscopy to rule out concurrent lower GI sources of bleeding 1, 6

• Atrophic gastritis: This more advanced form of gastritis can cause iron deficiency anemia through both bleeding and malabsorption, and carries increased risk for gastric cancer and neuroendocrine tumors 1

• Older adults: In elderly patients with iron deficiency (with or without anemia), endoscopic evaluation should be performed regardless of symptoms, as gastrointestinal malignancy is more common in this population 5

Clinical Pearls

• Erosive gastritis may be asymptomatic despite causing significant anemia 6
• H. pylori eradication alone can reverse iron deficiency anemia in some patients with H. pylori-associated gastritis 4
• Exercise-induced gastritis can cause significant blood loss but may respond well to acid suppression therapy 2
• The presence of iron deficiency anemia in a patient with erosive gastritis should not preclude evaluation for other potential sources of blood loss, particularly in older adults 1