Iron Therapy in Inflammatory Bowel Disease

Abstract

The most common complication seen in inflammatory bowel disease (IBD) patients is iron deficiency anaemia (IDA). Symptoms such as chronic fatigue can be as debilitating to IBD patients as pathological symptoms of abdominal pain and diarrhoea. Recognising and correcting anaemia may be as important as managing IBD symptoms and improving overall quality of life. Thus, iron replacement should be commenced the moment IDA is identified. Although intravenous iron is now considered standard treatment for IBD patients in Europe, oral iron still appears to be the preferred option. Advantages of oral iron include greater availability, lower costs and ease of applicability. However, its multitude of side effects, impact on the microbiome and further exacerbating IBD activity can have consequences on patient compliance. The newer oral iron formulations show promising safety and efficacy data with a good side effect profile. Intravenous iron formulations bypass the gastrointestinal tract absorption thereby leading to less side effects. Multiple studies have shown its superiority compared to oral formulations although its risk for hypersensitivity reactions continue to lead to clinician hesitancy in prescribing this formulation. This article provides an updated review on diagnosis and management of IDA in IBD patients, discussing the newer oral and intravenous formulations.

Small and Large Intestine (II): Inflammatory Bowel Disease, Short Bowel Syndrome, and Malignant Tumors of the Digestive Tract

“…Anemia is the most common systemic complication and extraintestinal manifestation of inflammatory bowel disease [ 25 ]. It is present in up to 70% of inpatients and 20% of outpatients with IBD [ 26 ]. It is the result of the combination of chronic iron deficiency, anemia of chronic disease, and other micronutrients deficiencies (folate, vitamin B12).…”

Iron Replacement Therapy with Oral Ferric Maltol: Review of the Evidence and Expert Opinion

“…In patients with iron-deficiency anemia, and in many of those with iron deficiency alone, iron replacement therapy is required in order to support physiologic processes and maintain quality of life, cognitive functioning, and the ability to complete daily activities. It has been estimated that 500 mg of absorbed iron are needed to raise hemoglobin levels by 2 g/dL, which is generally accepted as a meaningful increase in patients with anemia [ 24 ]; this amount can be delivered as a single intravenous (IV) iron infusion or as daily oral iron taken for ≥4 weeks [ 25 , 26 ]. However, although this amount of iron addresses the immediate needs of patients with anemia, it may not replenish the body’s iron stores sufficiently to overcome chronic iron deficiency.…”

“…However, although this amount of iron addresses the immediate needs of patients with anemia, it may not replenish the body’s iron stores sufficiently to overcome chronic iron deficiency. Particularly in patients with underlying inflammatory diseases, longer-term iron replacement therapy is required to raise and maintain iron stores physiologically, alongside the correction or control of the underlying condition to minimize further loss of iron [ 5 , 26 ].…”

“…However, the effectiveness of many oral formulations may be reduced by limited bioavailability, particularly in patients with underlying inflammatory conditions, because only 10–20% of iron from oral ferrous formulations is estimated to be absorbed [ 25 , 28 ]. Unabsorbed iron can form reactive hydroxyl radicals in the gut [ 26 , 29 , 30 , 31 , 32 ], leading to mucosal irritation or damage [ 26 , 29 , 32 , 33 , 34 , 35 , 36 ]. The resulting gastrointestinal adverse events, such as nausea, epigastric discomfort, and constipation, may reduce patients’ willingness to continue treatment [ 25 , 26 , 28 , 30 , 35 , 36 ].…”

“…Unabsorbed iron can form reactive hydroxyl radicals in the gut [ 26 , 29 , 30 , 31 , 32 ], leading to mucosal irritation or damage [ 26 , 29 , 32 , 33 , 34 , 35 , 36 ]. The resulting gastrointestinal adverse events, such as nausea, epigastric discomfort, and constipation, may reduce patients’ willingness to continue treatment [ 25 , 26 , 28 , 30 , 35 , 36 ]. Unabsorbed iron may also affect the gut microbiome [ 26 , 30 , 32 , 36 , 37 , 38 , 39 ] and can trigger disease flares in patients with IBD [ 26 , 31 , 33 , 36 , 37 ].…”