Role of iron deficiency anemia in inflammatory bowel disease

Abstract

Inflammatory bowel disease (IBD) is a relapsing chronic inflammatory disorder of the small and large gut with rising incidence and prevalence worldwide. Iron deficiency anemia is one of the most common extraintestinal manifestations of IBD, which correlates with the disease activity and tendency to relapse even after successful management. Anemia affects various aspects of quality of life, such as physical, cognitive, emotional, and workability, as well as healthcare costs. The anemia in IBD can be due to iron deficiency (ID) or chronic disease. The relative frequency of ID in IBD is 60%, according to some studies, and only 14% receive treatment. The evaluation of ID is also tricky as ferritin, being an inflammatory marker, also rises in chronic inflammatory diseases like IBD. The review of anemia in IBD patients involves other investigations like transferrin saturation and exploration of other nutritional deficiencies to curb the marker asthenia with which these patients often present. It underscores the importance of timely investigation and treatment to prevent long-term sequelae. We can start oral iron therapy in certain circumstances. Still, as inflammation of the gut hampers iron absorption, an alternative route to bypass the inflamed gut is usually recommended to avoid the requirement for blood transfusions.

Keywords: Colitis; Iron deficiency; Anemia; Inflammation; Ferritin

Core Tip: Iron deficiency is related to many complications in patients with inflammatory bowel disease (IBD) and further increases the mortality and morbidity in this patient group. The effective management of iron deficiency (ID) is essential to improve these patients' lifestyles and health-related complications. ID correlates with the disease activity in IBD and the tendency to relapse even after successful ID therapy. Parenteral iron therapy, a promising avenue, is showing potential in improving the target hemoglobin level in IBD patients.