Hemochromatosis is successfully controlled with Bariatric Surgery – Report of two Cases with long-term follow-up

Abstract

Abstract Introduction: In hereditary hemochromatosis the control of iron absorption is lost due to a mutation which leads to an iron overload. Therapy consists of regular phlebotomies to deplete the elevated iron deposits to prevent secondary organ damage. Contrarily, bariatric operations are known to induce iron deficiencies, which may arise from the substantial reduction in food intake. Iron deficiency in Roux-en-Y Gastric Bypass (RYGB) patients may also result from malabsorption (because the main sites of iron absorption have been bypassed) and from reduced bioavailability of dietary iron. Case Presentation: We present two obese patients with hereditary hemochromatosis which were treated with laparoscopic proximal gastric bypass and laparoscopic sleeve gastrectomy with a follow-up of 7 and 8 years. Both patients had a successful weight loss and control of their ferritin levels without further phlebotomies. The reduced iron intake and absorption after bariatric interventions seems to be outweighing the uncontrolled iron absorption in hemochromatosis. Conclusions: Bariatric operations are therefore able to control the iron overload in patients with hemochromatosis and eliminate the need for phlebotomies. There seems to be an advantage for gastric bypass over sleeve gastrectomy, most likely due to the bypassing of the main location of the iron uptake in the duodenum and the proximal jejunum.