Fe supplement in IBD

Q: For all of the following reasons intravenous (IV) Iron (Fe) is a preferred route of administration in Inflammatory bowel disease (IBD) except? 

 A) Oral Fe is associated with increased disease activity 
B) Oral Fe is associated with increased abdominal pain 
 C) Oral Fe is poorly absorbed  
D) IV Fe has better response in iron-restricted erythropoiesis 
 E) IV Fe causes better termination of gut's microbial diversity


Answer: E


Iron deficiency and iron deficiency anemia is a part of IBD. Many patients in ICU with exacerbation of IBD may require iron treatment for severe debilitating anemia. IV Iron is preferred for various reasons. Not only the oral Fe is associated with intolerance and abdominal pain (choice B) but can also exacerbate the disease activity (choice A). Due to inflammation, it is poorly absorbed (choice C). IV Fe has shown to better overcome the iron-restricted erythropoiesis which occurs due to systemic response in IBD (choice D).

Actually, microbial diversity is required to terminate the flare-ups of IBD and IV Fe helps in preserving that (see reference#3).

#hematology
#gastroenterology


References:

1. Gomollón F, Gisbert JP. Intravenous iron in inflammatory bowel diseases. Curr Opin Gastroenterol 2013; 29:201. 

2.  Erichsen K, Ulvik RJ, Nysaeter G, et al. Oral ferrous fumarate or intravenous iron sucrose for patients with inflammatory bowel disease. Scand J Gastroenterol 2005; 40:1058. 

3. Lee T, Clavel T, Smirnov K, et al. Oral versus intravenous iron replacement therapy distinctly alters the gut microbiota and metabolome in patients with IBD. Gut 2017; 66:863.