Management of inflammatory bowel disease-related anaemia and iron deficiency with specific reference to the role of intravenous iron in current practice

Stein J1,2,3, Aksan A1,4, Farrag K1,3, Dignass A1,5, Radeke HH1,2. Expert Opin Pharmacother. 2017 Oct 11. doi: 10.1080/14656566.2017.1391790. [Epub ahead of print]
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1 a Crohn Colitis Clinical Research Centre Rhein-Main , 60594 Frankfurt/Main , Germany. 2 b Department of Pharmaceutical Chemistry , University of Frankfurt , 60590 Frankfurt/Main , Germany. 3 c Gastroenterology and Clinical Nutrition , DGD Clinics Sachsenhausen , Schulstrasse 31, 60594 Frankfurt/Main , Germany. 4 d Faculty of Health Sciences , Hacettepe University , Ankara , Turkey. 5 e Department of Medicine I , Agaplesion Markus Hospital , 60431 Frankfurt/Main , Germany.


INTRODUCTION: Anaemia is a common extraintestinal manifestation in patients with inflammatory bowel disease, impacting disease prognosis, morbidity, hospitalisation rates and time lost from work. While iron deficiency anaemia and anaemia of chronic inflammation predominate, combinations of haematimetric and biochemical markers facilitate the diagnosis and targeted therapy of other aetiologies according to their underlying pathophysiological causes. Intravenous iron replacement is currently recommended in IBD patients with moderate to severe anaemia or intolerance to oral iron. Areas covered: This review examines the impact, pathophysiology and diagnostics of iron deficiency and anaemia, compares the characteristics and safety profiles of available oral and intravenous iron preparations, and highlights issues which require consideration in decision making for therapy administration and monitoring. Expert opinion: Modern intravenous ironformulations have been shown to be safe and effective in IBD patients, allowing rapid anaemia correction and repletion of iron stores. While traditional oral iron preparations are associated with increased inflammation, negative effects on the microbiome, and poor tolerance and compliance, first clinical trial data indicate that newer oral compounds such as ferric maltol and sucrosomial iron offer improved tolerability and may thus offer a viable alternative for the future.

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