Management of inflammatory bowel disease-related anemia 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 Nov;18(16):1721-1737. doi: 10.1080/14656566.2017.1391790. Epub 2017 Nov 5.

Author information

1 a Crohn Colitis Clinical Research Center Rhein-Main , Frankfurt/Main , Germany.

2 b Department of Pharmaceutical Chemistry , University of Frankfurt , Frankfurt/Main , Germany.

3 c Department of Gastroenterology and Clinical Nutrition , DGD Clinics Sachsenhausen , Frankfurt/Main , Germany.

4 d Faculty of Health Sciences , Hacettepe University , Ankara , Turkey.

5 e Department of Medicine I , Agaplesion Markus Hospital , Frankfurt/Main , Germany.


Anemia is a common extraintestinal manifestation in patients with inflammatory bowel disease, impacting disease prognosis, morbidity, hospitalization rates and time lost from work. While iron deficiency anemia and anemia of chronic inflammation predominate, combinations of hematimetric and biochemical markers facilitate the diagnosis and targeted therapy of other etiologies according to their underlying pathophysiological causes. Intravenous iron replacement is currently recommended in IBD patients with moderate to severe anemia or intolerance to oral iron. Areas covered: This review examines the impact, pathophysiology and diagnostics of iron deficiency and anemia, 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 iron formulations have been shown to be safe and effective in IBD patients, allowing rapid anemia 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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