Acid reflux occurs when stomach contents flow backward – or reflux – into the esophagus. While your stomach has a thick layer of neutralizing mucous to protect it from the acid it secretes, your esophagus does not. The result? Heartburn. Anyone can experience acid reflux from time to time, but if you experience it regularly you should see a doctor because you might have gastroesophageal reflux disease. Acid reflux can increase your risk of iron deficiency and also influences how the disease is treated.
In the 2008 edition of “Harrison’s Principles of Internal Medicine,” Harvard gastroenterologist Raj K. Goyal explains that acid reflux can damage the esophagus so severely that bleeding occurs. Because the blood is lost through stool, people don’t realize it and the condition goes untreated until iron deficiency develops. Using antacids and acid-controllers such as H2 blockers and proton pump inhibitors represents another risk factor for iron deficiency in people with acid reflux. Acid helps your body absorb iron in the foods you eat. Decreased absorption – especially if you consume a diet that is already low in iron – sets the stage for deficiency.
MedlinePlus says symptoms of iron deficiency include fatigue, weakness, shortness of breath upon exertion, sore tongue, pale skin, brittle nails, headaches and irritability. Symptoms are not always obvious in mild iron deficiency and usually become clear as deficiency progresses. Sticky, tarry-looking stools or stools that contain visible blood are signs of gastrointestinal bleeding. You might notice these signs before you experience symptoms of iron deficiency. If you experience any of these symptoms, see your doctor.
Your doctor will diagnose iron deficiency on the basis of a blood test for hemoglobin, hematocrit and ferritin. You do not need to fast before you have the blood test, but you should drink your usual amount of water or other fluids beforehand because dehydration can skew your results. Also mention whether you have recently given blood. If the blood test confirms iron deficiency, your gastroenterologist might recommend an endoscopy or other tests to determine whether your iron deficiency is caused by gastrointestinal bleeding.
Treatment for iron deficiency consists of iron supplements, but iron supplements often make acid reflux worse. Your gastroenterologist might tell you not to take iron supplements until your acid reflux is controlled. The usual supplement dose for iron deficiency is 325 milligrams, three times per day, but people with acid reflux often require more conservative doses of iron supplements or a different type of iron supplement – such as ferrous gluconate or ferrous fumarate instead of ferrous sulfate – than people without gastrointestinal problems. Work with your gastroenterologist to find the treatment that is right for you.
Symptoms of iron deficiency usually resolve within two months, but it takes six months to one year to replenish iron stores. If you have acid reflux, you might require longer treatment or follow-up blood tests, especially if you are not able to take a full dose of iron supplements or if you use antacids and acid controller medications that reduce your ability to absorb iron supplements.
- MedlinePlus: Iron Supplements
- The University of Chicago Medicine: Iron-Deficiency Anemia
- "Harrison's Principles of Internal Medicine, 23rd Edition”; Anthony S. Fauci, M.D. et al.; 2008