Iron Supplementation in Upper Non-variceal Gastrointestinal Bleeding

Inclusion Criteria:

1. age ≥ 65 years;

2. endoscopically proven acute nonvariceal GIB source;

3. 48 hours after the endoscopic diagnosis and/or treatment;

4. hemodynamically stable;

5. the discharge of the patient is planned;

6. hemoglobin level <10 g/dl on the day of randomisation;

7. 24 hours after the last transfusion and no need for further transfusion;

8. signed informed consent.

Exclusion Criteria:

1. known hypersensitivity to iron products (mild side effects excluded);

2. previous diagnosis of iron overload [e.g., transferrin receptor saturation (TSAT) >50%, ferritin> 160 for women ng/ml, ferritin >270 ng/ml for men) or disorders ofiron utilisation;

3. pregnancy or breast feeding;

4. diagnosis of iron malabsorption (at discretion of the attending clinician; e.g.,severe inflammatory bowel disease, active celiac disease);

5. chronic end stage diseases (chronic heart failure-New York Heart AssociationClassification class 4, chronic kidney disease (eGFR <30 mL/min/1.73 m2) with orwithout dialysis, liver cirrhosis with Child Pugh C score, chronic kidney diseasewith dialysis, chronic obstructive pulmonary disease stage 4, chronic inflammatorydisease, malignancies, AIDS);

6. active malignancies;

7. liver cirrhosis with known varices at high risk of bleeding - endoscopic features ofhigh risk of variceal bleeding or liver stiffness measured by transient elastography >20 kiloPascal and platelet count <150 × 10^9 cells/L;

8. gastrointestinal tract malignancies with high risk of gastrointestinal bleeding;

9. high risk of poor compliance or no fixed abode;

10. myelo- or lymphoproliferative diseases;

11. anemia not attributable to iron deficiency (sideroblastic anaemia, aplastic anaemia,haemolytic anaemia, thalassaemia, B12 vitamin or folic acid deficiency orcombination of these with IDA);

12. primary coagulation disorders (e.g. Glanzmann thrombasthenia, Von Willebranddisease, Haemophylia A, Haemophylia B);

13. the patient will be transferred to another institute after discharge (e.g. hospital,senior care center);

14. Eastern Cooperative Oncology Group (ECOG) Performance Status >2.