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Confocal laser endomicroscopy (CLE) is a more recent method to directly assess intestinal barrier function

The Mechanism of GI Distress : GI upset occurs because the majority of ingested iron is not absorbed and remains within the intestinal lumen, where it exerts local toxic effects by catalyzing the Fenton Reaction, generating reactive oxygen species (ROS) that cause Iron Pill Gastritis (erosions/ulcers) and Dysbiosis, where iron promotes the growth of enteropathogens while suppressing beneficial bacteria (Pantopoulos, 2024)

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, and this route of absorption is unaffected in patients with pernicious anemia