Management of Iron Deficiency Anaemia in Inflammatory Bowel Disease with Special Emphasis on Intravenous Iron

compared to extraintestinal disease complications such as arthritis or osteopathy, anaemia in IBD has received little attention. Anaemia is, however, the most common systemic manifestation of IBD 1,2 In a recent review by Gisbert and Gomollón, the prevalence of anaemia in patients with IBD ranged from 16% to 74%, varying from 16% outpatients to 68% in hospitalised patients2. Goodhand et al.3 demonstrated in a recent published prospective trial that anaemia and IDA are even more common in children than in older IBD patients, the prevalence of anaemia being 70% in children, 42% in adolescents, and 40% in adults. Overall, children (88%) and adolescents (83%) were more often iron-deficient than adults (55%). Anaemia is therefore the most prevalent extraintestinal manifestation in IBD patients.4 Anaemia represents the most frequent systemic manifestation of inflammatory bowel disease (IBD), and may not only affect quality of life and the ability to work, but also lead to an increased hospitalisation rate in these patients. Although the causes of anaemia in IBD are multifactorial, iron deficiency anaemia (IDA) and anaemia of chronic disease (ACD) are the most prevalent. In a condition associated with inflammation, such as IBD, assessment of iron status using the common biochemical values is insufficient. However, new iron indices such as reticulocyte haemoglobin content (CHr), percentage of hypochromic red cells (%HYPO) or zinc protoporphyrin (ZPP), may help to improve the assessment of iron status in IBD. Common treatment of IDA traditionally involves oral iron supplementation. However, because of extensive gastrointestinal side effects and data showing the use of oral iron in IBD to be possibly associated with disease exacerbation, recent guidelines suggest that, in IBD, the intravenous administration of iron supplementation should be preferred. On the basis of new experimental and clinical findings on the regulation of iron homeostasis, this article discusses improved diagnostic and therapeutic strategies, with special emphasis on new intravenous iron preparations. Management of Iron Deficiency Anaemia in Inflammatory Bowel Disease with Special Emphasis on Intravenous Iron