The Irony of Iron Pill Gastritis: A Case of Delayed Recognition and Persistent Injury in an Elderly Patient.

Iron pill gastritis is an underrecognized complication of oral solid iron supplementation, particularly in elderly patients. We present the case of an 83-year-old male with a history of hypertension, hyperlipidemia, type II diabetes, and chronic gastroesophageal reflux disease who developed gastric ulcers and erosions after three months of ferrous sulfate therapy for iron deficiency anemia. Esophagogastroduodenoscopy revealed nonbleeding ulcers and erosions, and biopsies confirmed iron pill gastritis. Despite recommendations to switch to liquid iron, the patient continued using solid tablets, resulting in persistent mucosal irritation. This case highlights the importance of early recognition, patient education, and consideration of liquid iron formulations in at-risk populations.