Abstract

Rational Management of Iron-Deficiency Anaemia in Inflammatory Bowel Disease

Nielsen OH1, Soendergaard C2, Vikner ME3, Weiss G4,5. Nutrients. 2018 Jan 13;10(1). pii: E82. doi: 10.3390/nu10010082.
 
     

Author information

1 Department of Gastroenterology, Herlev Hospital, University of Copenhagen, Herlev, DK-2730, Denmark. ohn@dadlnet.dk.

2 Department of Gastroenterology, Herlev Hospital, University of Copenhagen, Herlev, DK-2730, Denmark. christoffer.soendergaard@regionh.dk.

3 Department of Gastroenterology, Herlev Hospital, University of Copenhagen, Herlev, DK-2730, Denmark. malene.elbaek@mail.dk.

4 Department of Internal Medicine II, Medical University Hospital of Innsbruck, Innsbruck, A-6020, Austria. Guenter.Weiss@i-med.ac.at.

5 Christian Doppler Laboratory for Iron Metabolism and Anemia Research, University of Innsbruck, Innsbruck, A-6020, Austria.. Guenter.Weiss@i-med.ac.at.

Abstract

Anaemia is the most frequent, though often neglected, comorbidity of inflammatory bowel disease (IBD). Here we want to briefly present (1) the burden of anaemia in IBD, (2) its pathophysiology, which mostly arises from bleeding-associated iron deficiency, followed by (3) diagnostic evaluation of anaemia, (4) a balanced overview of the different modes of iron replacement therapy, (5) evidence for their therapeutic efficacy and subsequently, (6) an updated recommendation for the practical management of anaemia in IBD. Following the introduction of various intravenous iron preparations over the last decade, questions persist about when to use these preparations as opposed to traditional and other novel oral iron therapeutic agents. At present, oral iron therapy is generally preferred for patients with quiescent IBD and mild iron-deficiency anaemia. However, in patients with flaring IBD that hampers intestinal iron absorption and in those with inadequate responses to or side effects with oral preparations, intravenous iron supplementation is the therapy of choice, although information on the efficacy of intravenous iron in patients with active IBD and anaemia is scare. Importantly, anaemia in IBD is often multifactorial and a careful diagnostic workup is mandatory for optimized treatment. Nevertheless, limited information is available on optimal therapeutic start and end points for treatment of anaemia. Of note, neither oral nor intravenous therapies seem to exacerbate the clinical course of IBD. However, additional prospective studies are still warranted to determine the optimal therapy in complex conditions such as IBD.

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