This lesion, on the greater gastric curve, was found in a patient undergoing gastroscopy because of iron deficiency anaemia
WHAT IS THE LIKELY DIAGNOSIS?
■ Helicobacter associated gastritis
Can look odd but the yellow pigment doesn't fit
■ CMV gastritis
Nope, CMV would give a more widespread gastritis with erosions
■ Gastric lymphoma
Could look similar but how about that yellow stain?
■ Gastric cancer
Should always be suspected in IDA but wrong this time
■ Something else
Yes! Those yellow intramucosal crystals is iron!
This is the typical yellow/brown stain of "Iron tablet gastropathy". The intramucosal deposits of extracellular crystalline iron are best seen with the "Perl stain". The iron is an irritant, inducing inflammation and there is usually erythema of the surrounding mucosa (see another example below). Mucosal erosions and ulceration have also been described.
A liquid form of iron supplement is thought to be less toxic to the mucosa and when you see this, you should suggest changing the iron formulation ! In addition, patients are often advised to take the iron tablets on an empty stomach which also increases the risk of gastric irritation. I always advice patients to take the iron (tablets or liquid) with food !