Date Published: 
Wednesday, 22 May, 2013

Treating iron deficiency in patients with gastrointestinal disorders

Non-invasive, endoscopic and radiologic investigations and treatment of the underlying cause of iron deficiency in patients with gastrointestinal disorders are important to prevent further iron loss1. Iron stores can be replenished with iron supplementation and current guidelines recommend that the decision to treat iron deficiency in the absence of anaemia be taken in the context of the clinical significance of symptoms, the patient’s history and individual preference2-4. Iron therapy should always be initiated for iron deficiency with manifest anaemia1,3. Presence of fatigue or other iron deficiency-associated symptoms is clearly an indication for active treatment.

Oral iron

Oral iron therapy is convenient and inexpensive, but can be associated with gastrointestinal side effects that can limit tolerability and compliance with treatment5. Adverse effects include nausea, flatulence, diarrhoea and gastric erosion4. Animal and human studies indicate that the generation of reactive oxygen species by iron in the gastrointestinal tract can potentially lead to the exacerbation of inflammatory bowel disease4.

Oral iron therapy may not be effective in patients with chronic diseases or ongoing blood loss and guidelines for the treatment of iron deficiency in cancer and inflammatory bowel disease recommend first-line treatment with IV iron therapy3,6.

Intravenous iron

Intravenous iron is recommended for patients with intolerance, noncompliance or lack of response to oral iron, or for those with severe iron deficiency anaemia1,4,7. Clinical studies have shown that correction of iron deficiency in inflammatory bowel disease with IV, rather than oral iron is associated with significantly greater rates of response (Figure 4) and lower rates of adverse events and discontinuations8. IV iron has also been shown to provide significant improvements in quality of life in this population9.

Figure 4. Percentage of responses to IV and oral iron therapy in patients with inflammatory bowel disease8
















Copyright permission obtained from Lindgren et al, 2009.

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