Oral and intravenous iron treatment in inflammatory bowel disease: hematological response and quality of life improvement.
BACKGROUND
The aim was to evaluate the efficacy and tolerance of oral and intravenous iron treatment in anemic inflammatory bowel disease (IBD) patients, considering both hematological and quality-of-life outcomes.


METHODS
We performed a prospective multicenter study in IBD patients with iron deficiency anemia. Patients having hemoglobin >10 g/dL were prescribed oral ferrous sulfate. If hemoglobin <10 g/dL, intravenous (sucrose) iron was administered. Oral iron-intolerant patients were changed to intravenous treatment. Clinical (Truelove/Harvey-Bradshaw), hematological (response defined as hemoglobin normalization), and quality-of-life (shortened CCVEII-9 questionnaire) evaluations were performed at baseline and at 3 and 6 months.


RESULTS
100 IBD patients (59 Crohn's disease, 41 ulcerative colitis) were included. Mean basal hemoglobin levels were 10.8 +/- 1.3 g/dL (range, 6.6-12.9). Seventy-eight patients received oral treatment and 22 intravenous iron. Hemoglobin normalization was achieved in 86% of patients: 89% with oral, and 77% with intravenous iron. An IBD activity increase was not demonstrated in any patient. Four patients (5.1%) showed oral iron intolerance leading to discontinuation of treatment. No adverse events were reported for intravenous iron. Hemoglobin correlated with CCVEII-9 (P < 0.001). The CCVEII-9 score increased in patients who normalized hemoglobin levels in 3 months (from 58 +/- 9 to 73 +/- 10) or 6 months (54 +/- 9, 68 +/- 12, and 74 +/- 10) (P < 0.001).


CONCLUSIONS
Oral iron treatment is effective and well tolerated in most IBD patients, and does not exacerbate the symptoms of the underlying IBD. Intravenous iron, on the other hand, is an effective and safe alternative treatment for iron deficiency anemia in more severely anemic or intolerant patients. Anemia correction with iron treatment is associated with a relevant improvement in the patients' quality of life.
Gisbert
Javier P
JP
Hospital Universitario de la Princesa, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain. gisbert@meditex.es
Bermejo
Fernando
F
Pajares
Ramón
R
Pérez-Calle
Jose-Lázaro
JL
Rodríguez
María
M
Algaba
Alicia
A
Mancenido
Noemí
N
de la Morena
Felipe
F
Carneros
Jose Antonio
JA
McNicholl
Adrián G
AG
González-Lama
Yago
Y
Maté
José
J
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D018798:Anemia, Iron-Deficiency / Q000188:drug therapy* / Q000209:etiology; D003093:Colitis, Ulcerative / Q000150:complications* / Q000188:drug therapy; D003424:Crohn Disease / Q000150:complications* / Q000188:drug therapy; D005260:Female; D005296:Ferrous Compounds / Q000008:administration & dosage*; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult
D005296:Ferrous Compounds; D006454:Hemoglobins; C020748:ferrous sulfate