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Anaemic Inflammatory Bowel Disease Patients Can Receive Iron Treatment: Presented at UEGW

By Adrian Burton

MADRID, SPAIN -- November 4, 2003 -- Researchers from the U.K. report that sufferers of inflammatory bowel disease (IBD) who are also anaemic can safely be treated with oral iron.

"There is anecdotal evidence that many patients with IBD who are anaemic and who need iron supplements report intolerance," explained Anupama de Silva, MD, specialist registrar in gastroenterology at the Royal London Hospital, London, United Kingdom, speaking here November 3^rd at the 11^th United European Gastroenterology Week.

"There are also one or two case reports suggesting that oral iron actually exacerbates IBD," he said. "So we looked into the possibility that iron might be acting in a pro-inflammatory way [and] compared oral iron tolerance, efficacy and markers of inflammatory activity in IBD patients with those of patients who were iron deficient for other reasons."

The study involved 51 patients (16 with ulcerative colitis [UC], 20 with Crohn's disease [CD] and 15 non-IBD controls), all with iron deficiency defined as a serum haemoglobin level of <12.5 g/dL and ferritin level of <12 mcg/L. All were treated with 200 mg oral ferrous sulphate three times per day for four weeks.

Blood tests were performed before and after iron therapy to assess iron stores, disease activity and anti-oxidant capacity (AOC). All patients kept a diary card to monitor disease activity (the simple clinical colitis activity index for UC patients, the Harvey-Bradshaw Index for CD patients, and a symptoms score chart for non-IBD patients) for the week before and during treatment.

"We found a minority of patients were intolerant to iron in all the groups: 17% in ulcerative colitis, 18% in Crohn's disease and 24% in the non-IBD patients," explained Dr. de Silva. "But there was no significant difference between them."

Neither were any differences seen between symptom scores before and after treatment, as determined by the diary cards. Iron therapy was effective in the treatment of anaemia in the IBD patients, with haemoglobin levels rising from 10.5±1.7 g/dL before treatment to 11.7±1.4 g/dL after treatment (p < .005), and ferritin levels rising from 7.0±6.6 mcg/L to 20.7±11.4 (p < .0001). As expected, the oral iron was also effective in treating the non-IBD patients (Hb 10.2±0.7 before, 11.9±0.6 after, p < .0005; ferritin 5±2.1 before, 19±5.3 after, p < .0001). No changes were seen in AOC in either group of patients.

These results clearly suggest that IBD patients are no more intolerant of oral iron than anyone else. "If people do have IBD, and they are anaemic, you can give them the iron," concluded Dr. de Silva.


[Study title: Tolerance and Efficacy of Oral Iron Therapy in Patients With and Without Inflammatory Bowel Disease (IBD). Abstract MON-G-265]

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