Role of Oral Iron Supplementation for Anemia Secondary to Acute Nonvariceal Upper Gastrointestinal Bleeding: A Randomized Controlled Trial

Division of Gastroenterology, Department of Internal Medicine, Hatyai Hospital, Songkhla, Thailand. Siriraj Gastrointestinal Endoscopy Center, Division of Gastroenterology, Department of Internal Medicine, Siriraj Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand. Department of Internal Medicine, Hatyai Hospital, Songkhla, Thailand. Division of Hematology, Department of Internal Medicine, Hatyai Hospital, Songkhla, Thailand. NKC Institute of Gastroenterology and Hepatology, Faculty of Medicine, Songklanagarind Hospital, Prince of Songkla University, Songkhla, Thailand.

Journal of gastroenterology and hepatology. 2023
PICO Summary

Population

Patients with anaemia secondary to nonvariceal upper gastrointestinal bleeding (n= 151).

Intervention

Six weeks of 600 mg/d oral ferrous fumarate (treatment group, n= 77).

Comparison

No iron supplementation (control group, n= 74).

Outcome

The proportion of patients achieving composite haemoglobin response was greater in the treatment group than in the control group (72.7% vs. 45.9%; adjusted risk ratio [RR], 2.980). At end of treatment, the percentage change in the haemoglobin level (34.2 ± 24.8 % vs. 19.4 ± 19.9 %; adjusted coefficient, 11.543) was significantly higher in the treatment group than in the control group; however, the proportions of patients with a serum ferritin level <30 μg/L and a transferrin saturation <16% were lower in the treatment group. No significant differences in treatment-associated adverse effects and adherence rates were observed between the groups.
Abstract
BACKGROUND AND AIM Although acute upper gastrointestinal bleeding (UGIB) can lead to anemia, evidence regarding the effects of oral iron supplementation on UGIB-induced anemia following discharge remains lacking. The present study aimed to investigate the effects of oral iron supplementation on hemoglobin response and iron storage in patients with anemia secondary to nonvariceal UGIB. METHODS This randomized controlled trial included 151 patients with nonvariceal UGIB who had anemia at discharge. Patients were assigned to a 1:1 block in which they were either administered 6 weeks of 600 mg/d oral ferrous fumarate (treatment group, n=77) or treated without iron supplementation (control group, n=74). The primary outcome was composite hemoglobin response (hemoglobin elevation greater than 2 g/dL or no anemia at the end of treatment [EOT]). RESULTS The proportion of patients achieving composite hemoglobin response was greater in the treatment group than in the control group (72.7% vs. 45.9%; adjusted risk ratio [RR], 2.980; p=0.004). At EOT, the percentage change in the hemoglobin level (34.2 ± 24.8 % vs. 19.4 ± 19.9 %; adjusted coefficient, 11.543; p<0.001) was significantly higher in the treatment group than in the control group; however, the proportions of patients with a serum ferritin level <30 μg/L and a transferrin saturation <16% were lower in the treatment group (all p<0.05). No significant differences in treatment-associated adverse effects and adherence rates were observed between the groups. CONCLUSIONS Oral iron supplementation exerts beneficial effects on anemia and iron storage following nonvariceal UGIB without significantly impacting rates of adverse effects or adherence. CLINICAL TRIAL REGISTRATION TCTR20190225002.
Study details
Language : eng
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine