Alimentary Pharmacology and Therapeutics Letters to the Editors REFERENCES 1. Bager P, Dahlerup JF. Randomised clinical trial: oral vs. intravenous iron after upper gastrointestinal haemorrhage - a placebo-controlled study. Aliment Pharmacol Ther 2014; 39: 176–87.
Letter: the irony of oral iron – not an underdog for post-gastrointestinal bleeding anaemia; authors’ reply P. Bager & J. F. Dahlerup Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus C, Denmark. E-mail: [email protected] doi:10.1111/apt.12619
SIRS, We thank Molina-Infante and colleagues for their interest in our investigation and their awareness on the topic of anaemia and iron supplementation after acute upper gastrointestinal bleeding (AUGIB).1, 2 We fully agree that the main consequence of our findings must be that no patient should be discharged after AUGIB without iron supplementation whenever anaemia is present. Furthermore, blood samples should be taken as a follow-up to monitor the effect of the iron supplementation given. A suggestion could be after 1 and 3 months. A switch from oral iron to intravenous iron supplementation could be done, if the expected effect does not appear. As described in our paper, there are only limited data on how anaemic patients are monitored after discharge following AUGIB. We conducted a retrospective study on the prevalence of anaemia in AUGIB patients, the post-discharge iron treatment recommended, and the quality of follow-up.3 We found that 80% of patients were anaemic at discharge, only 16% of the anaemic patients were recommended iron supplementation, and the follow-up of patients was scattered and irregular.3
Letter: effects of gastric microenvironment on the management of iron deficiency anaemia S. Kılıncalp*, F. Karaahmet*, Y. Ustun*, S. Coban* & I. Yuksel*,†
Aliment Pharmacol Ther 2014; 39: 547-553 ª 2014 John Wiley & Sons Ltd
2. Villanueva C, Colomo A, Bosch A, et al. Transfusion strategies for acute upper gastrointestinal bleeding. N Engl J Med 2013; 368: 11–21.
Molina-Infante and colleagues also highlight that oral iron was found to be as effective as intravenous iron in treating anaemia and the use of proton pump inhibitors might have influenced these results.1 Several factors inhibit the enteral absorption of oral iron, such as proton pump inhibitors and inflammation in general.4, 5 We are currently analysing the patients’ levels of different markers such as C-reactive protein, ferritin, soluble transferrin receptor and hepcidin. We hope to be able to present a simple model in AUGIB patients to predict response and nonresponse to oral iron supplementation.
ACKNOWLEDGEMENTS The authors’ declarations of personal and financial interests are unchanged from those in the original article.2 REFERENCES 1. Molina-Infante J, Calvet X, Gispert JP. Letter: the irony of oral iron – not an underdog for post-gastrointestinal bleeding anaemia. Aliment Pharmacol Ther 2014; 39: 550–1. 2. Bager P, Dahlerup JF. Randomised clinical trial: oral vs. intravenous iron after upper gastrointestinal haemorrhage – a placebo-controlled study. Aliment Pharmacol Ther 2014; 39: 176–87. 3. Bager P, Dahlerup JF. Lack of follow-up of anaemia after discharge from an upper gastrointestinal bleeding centre. Dan Med J 2013; 60: A4583. 4. Ajmera AV, Shastri GS, Gajera MJ, Judge TA. Suboptimal response to ferrous sulfate in iron-deficient patients taking omeprazole. Am J Ther 2012; 19: 185–9. 5. von Drygalski A, Adamson JW. Iron metabolism in man. J Parent Ent Nutr 2013; 37: 599–606.
*Department of Gastroenterology, Dıskapı Yıldırım Beyazıt Educational and Research Hospital, Ankara, Turkey. † Department of Gastroenterology, Yıldırım Beyazıt University School of Medicine, Ankara, Turkey. E-mail: [email protected] doi:10.1111/apt.12622
551
Letter: the irony of oral iron – not an underdog for post-gastrointestinal bleeding anaemia; authors’ reply P. Bager & J. F. Dahlerup Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus C, Denmark. E-mail: [email protected] doi:10.1111/apt.12619
SIRS, We thank Molina-Infante and colleagues for their interest in our investigation and their awareness on the topic of anaemia and iron supplementation after acute upper gastrointestinal bleeding (AUGIB).1, 2 We fully agree that the main consequence of our findings must be that no patient should be discharged after AUGIB without iron supplementation whenever anaemia is present. Furthermore, blood samples should be taken as a follow-up to monitor the effect of the iron supplementation given. A suggestion could be after 1 and 3 months. A switch from oral iron to intravenous iron supplementation could be done, if the expected effect does not appear. As described in our paper, there are only limited data on how anaemic patients are monitored after discharge following AUGIB. We conducted a retrospective study on the prevalence of anaemia in AUGIB patients, the post-discharge iron treatment recommended, and the quality of follow-up.3 We found that 80% of patients were anaemic at discharge, only 16% of the anaemic patients were recommended iron supplementation, and the follow-up of patients was scattered and irregular.3
Letter: effects of gastric microenvironment on the management of iron deficiency anaemia S. Kılıncalp*, F. Karaahmet*, Y. Ustun*, S. Coban* & I. Yuksel*,†
Aliment Pharmacol Ther 2014; 39: 547-553 ª 2014 John Wiley & Sons Ltd
2. Villanueva C, Colomo A, Bosch A, et al. Transfusion strategies for acute upper gastrointestinal bleeding. N Engl J Med 2013; 368: 11–21.
Molina-Infante and colleagues also highlight that oral iron was found to be as effective as intravenous iron in treating anaemia and the use of proton pump inhibitors might have influenced these results.1 Several factors inhibit the enteral absorption of oral iron, such as proton pump inhibitors and inflammation in general.4, 5 We are currently analysing the patients’ levels of different markers such as C-reactive protein, ferritin, soluble transferrin receptor and hepcidin. We hope to be able to present a simple model in AUGIB patients to predict response and nonresponse to oral iron supplementation.
ACKNOWLEDGEMENTS The authors’ declarations of personal and financial interests are unchanged from those in the original article.2 REFERENCES 1. Molina-Infante J, Calvet X, Gispert JP. Letter: the irony of oral iron – not an underdog for post-gastrointestinal bleeding anaemia. Aliment Pharmacol Ther 2014; 39: 550–1. 2. Bager P, Dahlerup JF. Randomised clinical trial: oral vs. intravenous iron after upper gastrointestinal haemorrhage – a placebo-controlled study. Aliment Pharmacol Ther 2014; 39: 176–87. 3. Bager P, Dahlerup JF. Lack of follow-up of anaemia after discharge from an upper gastrointestinal bleeding centre. Dan Med J 2013; 60: A4583. 4. Ajmera AV, Shastri GS, Gajera MJ, Judge TA. Suboptimal response to ferrous sulfate in iron-deficient patients taking omeprazole. Am J Ther 2012; 19: 185–9. 5. von Drygalski A, Adamson JW. Iron metabolism in man. J Parent Ent Nutr 2013; 37: 599–606.
*Department of Gastroenterology, Dıskapı Yıldırım Beyazıt Educational and Research Hospital, Ankara, Turkey. † Department of Gastroenterology, Yıldırım Beyazıt University School of Medicine, Ankara, Turkey. E-mail: [email protected] doi:10.1111/apt.12622
551
