Anemia is a common extraintestinal manifestation in patients with
inflammatory bowel disease, impacting disease prognosis, morbidity, hospitalization rates and time lost from work. While
iron deficiency anemia and
anemia of chronic
inflammation predominate, combinations of hematimetric and
biochemical markers facilitate the diagnosis and targeted
therapy of other etiologies according to their underlying pathophysiological causes. Intravenous
iron replacement is currently recommended in IBD patients with moderate to severe
anemia or intolerance to oral
iron. Areas covered: This review examines the impact, pathophysiology and diagnostics of
iron deficiency and
anemia, compares the characteristics and safety profiles of available oral and intravenous
iron preparations, and highlights issues which require consideration in decision making for
therapy administration and monitoring. Expert opinion: Modern intravenous
iron formulations have been shown to be safe and effective in IBD patients, allowing rapid
anemia correction and repletion of
iron stores. While traditional oral
iron preparations are associated with increased
inflammation, negative effects on the microbiome, and poor tolerance and compliance, first clinical trial data indicate that newer oral compounds such as
ferric maltol and
sucrosomial iron offer improved tolerability and may thus offer a viable alternative for the future.