A recent article in Gastroenterology & Enoscopy News, “QI Pathway Improves Anemia Management in Pediatric IBD” (also presented at NASPGHAN 2018 -abstract 7, J Breton et al), discusses anemia and provides a link to CHOP QI Pathway for Anemia
This link contains useful information regarding treatment options and links to recommendations on management. This algorithm suggests using intravenous iron for anemia in all IBD patients with active disease as well as using intravenous iron for those with moderate to severe anemia. The rationale for parenteral iron in those with active disease is due to two factors:
- to overcome the block to intestinal iron absorption induced by hepcidin in the setting of inflammation (making oral iron less effective in active IBD regardless of disease location)
- due to data showing that oral iron may aggravate intestinal inflammation by altering the gut microbiome and increasing intestinal permeability
My take: The CHOP initiative provides some clear cut recommendations.for anemia in IBD. Parenteral iron is more efficacious in improving anemia; however, the effects of parenteral iron on the microbiome and other potential risks (eg. increased sepsis) are not clear. In my view, more information about outcomes and costs are needed to determine the optimal approach.
Related blog posts:
- Is It Right? Anti-TNF Therapy Does Not Fix IBD-Related Anemia
- Be Aggressive! Treating Anemia Associated with Inflammatory Bowel Disease | gutsandgrowth
- Microcytic Anemia Review | gutsandgrowth
- IBD Update January 2015 (Part 2) | gutsandgrowth
- Help with hepcidin | gutsandgrowth
- Inadequate treatment of anemia in IBD | gutsandgrowth
Disclaimer: These blog posts are for educational purposes only. Specific dosing of medications/diets (along with potential adverse effects) should be confirmed by prescribing physician/nutritionist. This content is not a substitute for medical advice, diagnosis or treatment provided by a qualified healthcare provider. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a condition.