Background: No study has compared changes in quality of life (QoL) following iron therapy between anemic and non-anemic, hypoferritinemic patients. This study compares the impact of parenteral iron replacement on QoL in inflammatory bowel disease (IBD) patients with anemia, or in those with hypoferritinemia alone. Methods: Consecutive IBD patients diagnosed with anemia or hypoferritinemia were enrolled. IBD questionnaire (IBDQ) and 36-Item Short Form Survey (SF36) at diagnosis and 6 weeks post treatment were measured. Results: Ten patients with anemia and 13 with hypoferritinemia were treated with intravenous iron polymaltose. Across all patients, there was a significant improvement in median SF36 mental component score by 8.5 (p = 0.004) and median IBDQ by 12 (p = 0.02). There was a trend towards improved median SF36 physical component score by 3.2 (p = 0.6). These changes were not significantly different when comparing anemic with hypoferritinemic patients. In IBDQ, there was a trend toward greater improvement in hypoferritinemic vs. anemic patients (20 vs. 1.5, p = 0.31). Conclusions: This is the first study to show that improvements in QoL in hypoferritinemic patients are similar to those with anemia. Based on these results, patients with IBD should be offered the option of iron therapy when they are found to be hypoferritinemic, even in the absence of anemia.

1.
Dignass AU, Gasche C, Bettenworth D, Birgegard G, Danese S, Gisbert JP, Gomollon F, Iqbal T, Katsanos K, Koutroubakis I, Magro F, Savoye G, Stein J, Vavricka S; European Crohn's and Colitis Organisation [ECCO]: European consensus on the diagnosis and management of iron deficiency and anaemia in inflammatory bowel diseases. J Crohns Colitis 2015;9:211-222.
2.
Wells CW, Lewis S, Barton JR, Corbett S: Effects of changes in hemoglobin level on quality of life and cognitive function in inflammatory bowel disease patients. Inflamm Bowel Dis 2006;12:123-130.
3.
Cucino C, Sonnenberg A: Cause of death in patients with inflammatory bowel disease. Inflamm Bowel Dis 2001;7:250-255.
4.
Wilson A, Reyes E, Ofman J: Prevalence and outcomes of anemia in inflammatory bowel disease: a systematic review of the literature. Am J Med 2004;116(suppl 7A):44S-49S.
5.
Kulnigg S, Gasche C: Systematic review: managing anaemia in Crohn's disease. Aliment Pharmacol Ther 2006;24:1507-1523.
6.
Lomer MC, Kodjabashia K, Hutchinson C, Greenfield SM, Thompson RP, Powell JJ: Intake of dietary iron is low in patients with Crohn's disease: a case-control study. Br J Nutr 2004;91:141-148.
7.
de Vizia B, Poggi V, Conenna R, Fiorillo A, Scippa L: Iron absorption and iron deficiency in infants and children with gastrointestinal diseases. J Pediatr Gastroenterol Nutr 1992;14:21-26.
8.
Semrin G, Fishman DS, Bousvaros A, Zholudev A, Saunders AC, Correia CE, Nemeth E, Grand RJ, Weinstein DA: Impaired intestinal iron absorption in Crohn's disease correlates with disease activity and markers of inflammation. Inflamm Bowel Dis 2006;12:1101-1106.
9.
Gasche C, Berstad A, Befrits R, Beglinger C, Dignass A, Erichsen K, Gomollon F, Hjortswang H, Koutroubakis I, Kulnigg S, Oldenburg B, Rampton D, Schroeder O, Stein J, Travis S, Van Assche G: Guidelines on the diagnosis and management of iron deficiency and anemia in inflammatory bowel diseases. Inflamm Bowel Dis 2007;13:1545-1553.
10.
de Silva AD, Tsironi E, Feakins RM, Rampton DS: Efficacy and tolerability of oral iron therapy in inflammatory bowel disease: a prospective, comparative trial. Aliment Pharmacol Ther 2005;22:1097-1105.
11.
Uritski R, Barshack I, Bilkis I, Ghebremeskel K, Reifen R: Dietary iron affects inflammatory status in a rat model of colitis. J Nutr 2004;134:2251-2255.
12.
Carrier J, Aghdassi E, Platt I, Cullen J, Allard JP: Effect of oral iron supplementation on oxidative stress and colonic inflammation in rats with induced colitis. Aliment Pharmacol Ther 2001;15:1989-1999.
13.
Werner T, Wagner SJ, Martinez I, Walter J, Chang JS, Clavel T, Kisling S, Schuemann K, Haller D: Depletion of luminal iron alters the gut microbiota and prevents Crohn's disease-like ileitis. Gut 2011;60:325-333.
14.
Reinisch W, Staun M, Bhandari S, Munoz M: State of the iron: how to diagnose and efficiently treat iron deficiency anemia in inflammatory bowel disease. J Crohns Colitis 2013;7:429-440.
15.
Cekic C, Ipek S, Aslan F, Akpinar Z, Arabul M, Topal F, Saritas Yuksel E, Alper E, Unsal B: The effect of intravenous iron treatment on quality of life in inflammatory bowel disease patients with nonanemic iron deficiency. Gastroenterol Res Pract 2015;2015:582163.
16.
Sobrado CW, Cancado RD, Sobrado LF, Frugis MO, Sobrado MF: Treatment of anemia and improvement of quality of life among patients with Crohn's disease: experience using ferric carboxymaltose. Arq Gastroenterol 2015;52:255-259.
17.
Herrera-deGuise C, Casellas F, Robles V, Navarro E, Borruel N: Iron deficiency in the absence of anemia impairs the perception of health-related quality of life of patients with inflammatory bowel disease. Inflamm Bowel Dis 2016;22:1450-1455.
18.
Silverberg MS, Satsangi J, Ahmad T, Arnott ID, Bernstein CN, Brant SR, Caprilli R, Colombel JF, Gasche C, Geboes K, Jewell DP, Karban A, Loftus EV Jr, Pena AS, Riddell RH, Sachar DB, Schreiber S, Steinhart AH, Targan SR, Vermeire S, Warren BF: Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. Can J Gastroenterol 2005;19(suppl A):5A-36A.
19.
Harvey RF, Bradshaw JM: A simple index of Crohn's-disease activity. Lancet 1980;1:514.
20.
Walmsley RS, Ayres RC, Pounder RE, Allan RN: A simple clinical colitis activity index. Gut 1998;43:29-32.
21.
Guyatt G, Mitchell A, Irvine EJ, Singer J, Williams N, Goodacre R, Tompkins C: A new measure of health status for clinical trials in inflammatory bowel disease. Gastroenterology 1989;96:804-810.
22.
Ware JE Jr, Sherbourne CD: The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 1992;30:473-483.
23.
Schroder O, Mickisch O, Seidler U, de Weerth A, Dignass AU, Herfarth H, Reinshagen M, Schreiber S, Junge U, Schrott M, Stein J: Intravenous iron sucrose versus oral iron supplementation for the treatment of iron deficiency anemia in patients with inflammatory bowel disease - a randomized, controlled, open-label, multicenter study. Am J Gastroenterol 2005;100:2503-2509.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.