Iron deficiency anemia is the most common form of
anemia worldwide, caused by poor
iron intake, chronic blood loss, or impaired absorption. Patients with
inflammatory bowel disease (IBD) are increasingly likely to have
iron deficiency anemia, with an estimated prevalence of 36%-76%. Detection of
iron deficiency is problematic as outward signs and symptoms are not always present.
Iron deficiency can have a significant impact on a patient's quality of life, necessitating prompt management and treatment. Effective treatment includes identifying and treating the underlying cause and initiating
iron replacement
therapy with either oral or intravenous
iron. Numerous formulations for oral
iron are available, with
ferrous fumarate,
sulfate, and
gluconate being the most commonly prescribed. Available intravenous formulations include
iron dextran,
iron sucrose,
ferric gluconate, and
ferumoxytol. Low-molecular weight
iron dextran and
iron sucrose have been shown to be safe, efficacious, and effective in a host of
gastrointestinal disorders.
Ferumoxytol is the newest US Food and Drug Administration-approved intravenous
iron therapy, indicated for
iron deficiency anemia in adults with
chronic kidney disease.
Ferumoxytol is also being investigated in Phase 3 studies for the treatment of
iron deficiency anemia in patients without
chronic kidney disease, including subgroups with IBD. A review of the efficacy and safety of
iron replacement in IBD, therapeutic considerations, and recommendations for the practicing gastroenterologist are presented.