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World J Gastroenterol. Aug 21, 2026; 32(31): 119263
Published online Aug 21, 2026. doi: 10.3748/wjg.119263
Published online Aug 21, 2026. doi: 10.3748/wjg.119263
Disrupted coupling between ferritin and iron absorption in enteropathy-related anemia: Evidence for a dual-pathway model
Olesja Basina, Aleksejs Derovs, VCA Gastroenterology and Endoscopy Department, VCA, Riga LV1035, Riga, Latvia
Olesja Basina, Jelena Derova, Nikola Krumina, Sandra Lejniece, Aleksejs Derovs, Department of Internal Diseases, Riga Stradins University, Riga LV1007, Riga, Latvia
Olesja Basina, Aleksejs Derovs, Outpatient Department Unit, Riga East University Hospital, Riga LV1038, Riga, Latvia
Jelena Derova, Aleksejs Derovs, Department of Gastroenterology, Latvian Maritime Medicine Centre, Riga LV1005, Riga, Latvia
Jelena Derova, Aleksejs Derovs, Digestive Disease Society of Latvia, Jurmala LV2010, Jurmala, Latvia
Maksims Zolovs, Statistics Unit of RSU Faculty of Medicine, Riga Stradins University, Riga LV1007, Riga, Latvia
Maksims Zolovs, Institute of Life Sciences and Technology, Daugavpils University, Daugavpils LV5401, Augsdaugava, Latvia
Sandra Lejniece, Hematology Clinic, Riga East University Hospital, Riga LV1038, Riga, Latvia
Author contributions: Lejniece S and Derovs A designed the research study; Basina O and Derova J performed the research; Basina O, Derova J, and Derovs A contributed clinical data; Basina O and Zolovs M analyzed the data; Basina O and Krumina N wrote the manuscript; Derovs A revised the manuscript. All authors have read and approved the final manuscript.
AI contribution statement: ChatGPT was used for language editing of selected passages in the Introduction and Discussion. No part of the manuscript was AI-generated. The study concept, design, data collection, statistical analysis, and all scientific conclusions are the work of the authors. AI use was limited to language editing only. No AI tool was involved in study design or interpretation of results. No images were AI-generated. The authors also note that AI screening was not performed at submission or during peer review - the stages where such checks are standard practice in other journals. Raising this issue at the production stage, after formal acceptance, is procedurally irregular. AI detection tools produce false positives, and this is especially common in manuscripts written in rigorous academic English by experienced researchers.
Institutional review board statement: The study was approved by the Riga East University Hospital Support Foundation Medical and Biomedical Research Ethics Committee (protocol No. 10-A/14) and conducted in accordance with the Declaration of Helsinki.
Informed consent statement: All involved persons (subjects) gave their written informed consent prior to study inclusion.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article. Article processing charge support from Riga Stradins University no direct personal payment to the author.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author upon reasonable request at olesja.basina@rsu.lv. Participants consent for data sharing was not obtained but the presented data are anonymized and risk of identification is low.
Corresponding author: Olesja Basina, MD, Chief Physician, Doctorate Student, Lecturer, VCA Gastroenterology and Endoscopy Department, VCA, Nicgales Street 5, Riga LV1035, Riga, Latvia. olesja.basina@rsu.lv
Received: January 26, 2026
Revised: March 13, 2026
Accepted: April 22, 2026
Published online: August 21, 2026
Processing time: 190 Days and 19.7 Hours
Revised: March 13, 2026
Accepted: April 22, 2026
Published online: August 21, 2026
Processing time: 190 Days and 19.7 Hours
Core Tip
Core Tip: Iron deficiency anemia without overt gastrointestinal bleeding remains a diagnostic challenge, particularly in patients with suspected small-bowel disease. In this study, we integrated video capsule endoscopy findings with an oral iron absorption test, serum iron biomarkers, and fatigue scores. Our results demonstrate that enteropathy independently impairs intestinal iron absorption and alters ferritin levels, yet without a direct association between these two processes. This dissociation suggests that ferritin alone may not accurately reflect functional iron deficiency in enteropathy and highlights the importance of assessing small-bowel mucosal integrity in patients with unexplained anemia or fatigue.