Supplementary Material for: Iron Mettle- Unveiling an Unusual Incidental Case Report of Esophageal Ulcer

Background: Erosive injury to the upper gastrointestinal tract caused by therapeutic oral iron supplements is a rare occurrence. Although erosive injury to the mucosa of the upper gastrointestinal (GI) tract is commonly associated with overdoses of oral iron supplements, similar injuries can also occur with doses within the normal therapeutic range. Reports have documented upper gastrointestinal disorders induced by iron, primarily affecting the stomach and occasionally the esophagus. Iron preparations are initially absorbed as ferrous iron and then oxidized to ferric iron. Excess ferric iron, surpassing the binding capacity of transferrin, a binding protein, leads to cellular damage. Ferric iron directly corrodes the gastrointestinal mucosa and disrupts various cellular processes by generating free radicals and initiating lipid peroxidation.Case Description:A 55-year-old female with dysphagia, pain and anorexia showed linear to circumferential ulcers covered extensively with white slough around the central esophagus with thickened and erythematous mucosa with focal erosions on esophagogastroduodenoscopy. Conclusions:This case highlights a rare case report of Iron- Induced esophageal ulcer found incidentally and the significance of acknowledging that iron preparations can harm the esophageal mucosa especially in an Indian population where anemia is fairly predominant.