Treatment of Iron Deficiency Anaemia in Inflammatory Bowel Disease With Ferrous Sulphate
Status:
Completed
Trial end date:
2015-06-01
Target enrollment:
Participant gender:
Summary
Iron deficiency anaemia is common in inflammatory bowel disease (IBD), affecting at least 20%
patients at any one time. Hepcidin, a recently described anti-microbial peptide synthesized
by the liver, is a key regulator of iron homeostasis. It interferes with absorption of iron
into enterocytes, macrophages and hepatocytes by binding to ferroportin. Hepcidin levels rise
when total body iron levels rise and protect against iron overload; conversely, in iron
deficiency, levels are low. Hepcidin levels also rise under the influence of interleukins
(IL)-6 and -1, a factor likely to contribute to iron deficient erythropoesis in active IBD.
Whether hepcidin levels predict resistance to oral iron therapy in IBD is unknown, though it
may impair its immediate oral absorption. Adult IBD patients who are anaemic report quality
of life and fatigue scores comparable to those seen in malignancy.
IBD diagnosed in adolescence interferes with growth, education and employment as well as
psychosocial and sexual development. Not surprisingly, adolescents with IBD have a high
prevalence of psychological distress, particular depression. Limited historical, and our own
data suggest that children and adolescents with IBD are more anaemic than adults, and less
often treated with oral iron. What is not clear is whether the apparent under-utilisation of
oral iron in paediatric care is because of a perceived lack of benefit or doctors' concerns
about possible side effects including worsening disease activity.
To address these questions, the investigators propose a comparative study of 6 weeks of oral
iron supplementation in adolescents and adults with iron deficiency anaemia in IBD. Patients
will be given oral iron supplementation. Before and after iron therapy, the investigators
shall assess haemoglobin concentrations; IBD activity; quality of life (QOL), perceived
stress, mood and fatigue; iron metabolism, including serum hepcidin.