Anemia and iron deficiency in gastrointestinal and liver conditions

Abstract

Iron deficiency anemia (IDA) is associated with a number of pathological gastrointestinal conditions other than inflammatory bowel disease, and also with liver disorders. Different factors such as chronic bleeding, malabsorption and inflammation may contribute to IDA. Although patients with symptoms of anemia are frequently referred to gastroenterologists, the approach to diagnosis and selection of treatment as well as follow-up measures is not standardized and suboptimal. Iron deficiency, even without anemia, can substantially impact physical and cognitive function and reduce quality of life. Therefore, regular iron status assessment and awareness of the clinical consequences of impaired iron status are critical. While the range of options for treatment of IDA is increasing due to the availability of effective and well-tolerated parenteral iron preparations, a comprehensive overview of IDA and its therapy in patients with gastrointestinal conditions is currently lacking. Furthermore, definitions and assessment of iron status lack harmonization and there is a paucity of expert guidelines on this topic. This review summarizes current thinking concerning IDA as a common co-morbidity in specific gastrointestinal and liver disorders, and thus encourages a more unified treatment approach to anemia and iron deficiency, while offering gastroenterologists guidance on treatment options for IDA in everyday clinical practice.

The association of pre‐operative anaemia with survival after orthotopic liver transplantation

“…Acute and chronic gastro-intestinal haemorrhage, malnutrition, iron deficiency, folate or vitamin B12 deficiency and suppression of bone marrow are mainly responsible for anaemia in end-stage liver disease patients [9,[25][26][27][28]. Increasing pre-operative haemoglobin [29][30][31][32].…”

Overview of Home Parenteral Nutrition: An Update

“…Iron deficiency has been identified in patients receiving HPN 28 . Oral iron administration should be attempted.…”

“…Iron deficiency has been identified in patients receiving HPN. 28 Oral iron administration should be attempted. The use of iron dextran in lipid-free HPN solutions has been used after successful administration of a test dose of iron dextran in a monitored setting.…”

Randomised clinical trial: intravenous vs oral iron for the treatment of anaemia after acute gastrointestinal bleeding

“…The treatment of GIB‐associated anaemia, therefore, requires both correction of the underlying cause and adequate repletion of iron stores in case of IDA . Despite the known frequency of GIB and the negative consequences of IDA, guidelines for the effective treatment of GIB‐associated anaemia remain poorly defined …”

“…Oral administration of ferrous sulphate (FeSulf) is still re‐cognised as the first‐line treatment for IDA patients. However, for patients with gastrointestinal disorders, oral iron shows substantial limitations due to insufficient absorption, slow course of action and severe gastrointestinal side effects that can exacerbate existing symptoms . Due to this intolerance, it is estimated that oral iron treatment is discontinued in up to 50% of IDA patients …”