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Iron therapy in Inflammatory Bowel Disease what you need to know

Inflammatory bowel disease, IBD, is a condition that causes irritation and ulcers in the gastrointestinal tract.

It is a group of inflammatory conditions of the large intestine and, in some cases, the small intestine.

The most common for IBD are ulcerative colitis and Crohn's disease.

Anemia caused by iron deficiency due to gastrointestinal blood loss and reduced iron absorption due to inflammation is often present.

It may also be exacerbated by a restrictive diet.

  • In the US it is estimated that currently 1 – 1,3 million people are suffering from IBD.
  • Crohn's disease and Ulcerative Colitis have together and incidence of 339 per 100 000 adults (cdc.gov)
  • The number is higher in Europe and increasing everywhere.
Anemia common in IDB

"Anemia, a common complication associated with inflammatory bowel disease (IBD), is frequently overlooked in the management of IBD patients. Unfortunately, it represents one of the major causes of both decreased quality of life and increased hospital admissions among this population. Anemia in IBD is pathogenically complex, with several factors contributing to its development." (Anemia in inflammatory bowel disease: A neglected issue with relevant effects. World J Gastroenterol. 2014 Apr 7; 20(13): 3542–3551. Danila Guagnozzi and Alfredo J Lucendo)

Treatment today consists mainly of oral non-heme iron prior to intravenous iron and erythropoietin treatment.

"Anemia correction with iron treatment is associated with a relevant improvement in the patients' quality of life." (Oral and intravenous iron treatment in inflammatory bowel disease: hematological response and quality of life improvement." Inflamm Bowel Dis. 2009 Oct;15(10):1485-91. doi: 10.1002/ibd.20925 Gisbert et al.)

The prevalence of intolerance towards oral non-heme iron is around 25 %.

"CONCLUSIONS: Oral ferrous fumarate, but not intravenous iron sucrose, increased clinical disease activity in IBD patients. Intravenous iron sucrose increased intravascular oxidative stress." Oral ferrous fumarate or intravenous iron sucrose for patients with inflammatory bowel disease. Erichsen et al. Scand J Gastroenterol. 2005 Sep;40(9):1058-65.

Heme iron is well-tolerated and efficient

The absorption of heme iron is several times higher and the side-effects rate significantly lower than for non-heme oral iron.

Heme iron is absorbed through a separate pathway and does not have to be discontinued when intravenous treatment is started.

This can allow for longer intervals between resource-heavy, inconvenient and painful injections.

Intravenous treatment is usually started only when oral non-heme treatment fails due to side-effects.

Heme iron allows for self-medication because of better tolerance.

It would thus mean a significant gain in the patient Quality of Life. It gives freedom to travel, for instance.

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