Therapeutic response to ferric hydroxide versus ferrous glycine sulfate in pediatric autoimmune gastritis-related iron deficiency anemia.

Authors

Joana Carvalho Queirós, Inês Aires Martins, Ana Lachado, Francisco Ribeiro-Mourão, Helena Moreira-Silva, Isabel Couto Guerra, Marta Tavares, Emília Costa, Rosa Lima

Published in

Journal of pediatric gastroenterology and nutrition. Sep 07, 2026. Epub Sep 07, 2026.

Abstract

Autoimmune gastritis (AIG) is characterized by immune-mediated destruction of gastric parietal cells and impaired iron absorption. Refractory iron deficiency anemia (IDA) is often the main clinical presentation in pediatric patients. Because oral ferrous glycine sulfate (FGS) is absorbed independently of gastric pH, it may represent an effective alternative to ferric hydroxide (FH) in this setting.
To compare the therapeutic response to FH and FGS in children and adolescents with AIG-associated IDA.
We conducted a retrospective observational cohort study including pediatric patients diagnosed with AIG-associated IDA and followed at a tertiary Pediatric Gastroenterology Unit between 2007 and 2023. Treatment non-response was defined as a hemoglobin (Hb) increase <1 g/dL after 4 weeks of therapy and/or failure to normalize ferritin after 3 months.
Thirty-two patients were included (71% female; median age 12 years). IDA was the presenting feature in 94% of cases. Median baseline Hb was 9.8 g/dL and ferritin was 5 ng/mL. Thirty patients had previously received FH, of whom only four achieved an adequate response. The remaining 26 patients showed minimal improvement in Hb and ferritin and were subsequently switched to FGS. After switching, a significant increase in Hb and ferritin was observed (both p < 0.001), with normalization of Hb and ferritin achieved in 86% and 81% of patients, respectively. Two patients treated initially with FGS also demonstrated favorable hematologic responses.
In this retrospective cohort, FGS was associated with substantial hematologic improvement in pediatric patients with AIG-associated IDA, particularly in those who had failed previous FH therapy.

PMID:
42706716
Bibliographic data and abstract were imported from PubMed on 08 Sep 2026.

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