Efficacy and usage of oral iron therapy in inflammatory bowel disease

Abstract

Background:Anecdotal evidence suggests that oral iron preparations are frequently ineffective, poorly tolerated and may even increase disease activity in patients with IBO, but there appears to be no formal support for these assertions in the literature. Aim: To compare the tolerance and outcome of oral iron therapy in patients with IBD and non-inflammatory causes of anaemia. Methods: The case records of 87 consecutive patients with Crohn's disease, ulcerative colitis and indeterminate colitis attending this hospital during the period 1996-1999 were reviewed retrospectively using a standard proforma. The notes of patients with IBD who had received treatment with oral iron preparations were compared with those of 20 patients who were given oral iron for anaemia due to other causes (NSAID usage 4, dietary 3, mennorhagia 3, multitactorial 2, gastritis 2, colonic angiodysplasia 1, coeliac disease 1, unspecified 2) Results: Of the IBD group, 41/87 (47%) patients were given oral iron treatment during this period (ferrous sulphate 66%, sodium iron edetate 10%, ferrous fumarate 10%, ferrous gluconata 2%, unspecified 12%); the non-IBO anaemic patients were given ferrous sulphate (80%), sodium iron edetate (5%) or an unspecified iron preparation (15%). 10/41 (24%) I BD patients were intolerant of oral iron (nausea, dyspepsia, abdominal pain, diarrhoea and/or constipation) compared to 4/20 (20%) non-IBD patients. In 2/10 IBD patients who were iron-intolerant, disease activity worsened (as shown by increases in ESR, CRP and platelet count) during iron therapy. In 17/24 (71%) IBD patients in whom response to treatment was adequately assessed, oral iron produced satisfactory repletion of iron stores in 3-6 months, compared with 8/15 (53%) patients in the non-IBD anaemic group. Conclusions: (1) Oral iron therapy is effective in the majority of patients with IBD-associated anaemia. (2) Patients with IBI) appear to tolerate oral iron as well as those with anaemia due to other causes. (3) In a minority of iron-intolerant patients with IBD, this therapy may be associated with an increase in disease activity.