Microsoft Word - AHA056BF

No Malabsorption of Inorganic Ferrous Iron in Patients with Achylia gastrica Celada et al. [1] recently described in this journal a considerable malabsorption of 59pe2+ for subjects with achylia gastrica. The authors have used the same test dose of 0.56 mg 59Fe2+ and the technique of whole body counting of absorbed 5βFe as proposed by us [7] but their results are in contradiction with published work from our [3-6] and another laboratory [8]. Neither normal gastric juice nor an intrinsic factor is required for the intestinal absorption of 59Fe2+ or hemoglobin-39Fe in humans [3-6]. Subjects with histamine-re-fractive achylia gastrica and absolute intrinsic factor deficiency (pernicious anemia in remission) absorbed 27 ± 15% [3, 5, 6] and subjects with a partial gastrectomy (Billroth I and II) 32 ± 15% [6], which was identical with the absorption of 31 ± 12% as observed for the 10 μrnoi (= 0.56 mg) sθpe2+ test dose m normal subjects [2-6]. Magnusson did confirm our results since he found no indications for iron malabsorption from the 0.56 mg 59Fe2+-dose in patients with Billroth ∏-partial gastrectomy or an-trectomy and gastroduodenostomy with or without vagotomy [8]. 59Fe2+ malabsorption (5.1 ± 3.3%) was observed only in patients with a total gastrectomy [6]. Hemoglobin 59Fe was even better absorbed (2-fold) by subjects with achylia gastrica and absolute intrinsic factor deficiency (15 ± 5.6% from a 5 mg hemoglobin-Fe dose versus 7.5 ± 2.4% in normal subjects) [3, 5], since the acidity of normal gastric juice does reduce the bioavailability of hemoglobin-iron probably by heme-polymeri-zation and precipitation [4]. A 3-fold reduction of intrinsically 59Fe-labeled meat-(and liver-)iτon bioavailability was, however, demonstrated for subjects with gastric mucosa atrophy or Billroth II partial gastrectomy [4] and confirmed with an extrinsically 59Fe-labeled test meal for subjects after antrectomy or partial gastrectomy [8]. This reduced bioavailability is however caused by, e.g., meat iron mal-digestion and not by malabsorption since it can be corrected by an in vitro peptic pre-digestion of the 59Fe-labeled pork [4]. The normal absorption of ferrous iron, the doubled hemiglobin-iron absorption and the considerable reduction of meatand liver-iron favour the assumption that dietary iron maldigestion rather than malabsorption causes the development of iron deficiency in patients with achylia gastrica or partial gastrectomy [4]. Patients with achylia gastrica No Malabsorption of Inorganic Ferrous Iron in Patients with Achylia gastrica 57 and iron deficiency anemia do absorb iron from therapeutic oral ferrous sulphate iron preparations like normal subjects and are not resistant to oral iron therapy and do not require parenteral iron. References Celada, A.; Rudolf, H.; Herreros, V., and Donath, A.: Inorganic iron absorption in subjects with iron deficiency anemia, achylia gastrica and alcoholic cirrhosis using a whole body counter. Acta haemat. 60: 182-192 (1978).