However , in patients with IBD flares and inadequate responses to or side effects with oral preparations , intravenous iron supplementation is the therapy of choice .
Neither oral nor intravenous therapy seems to exacerbate the clinical course of IBD , and intravenous iron therapy can be administered even in active disease stages and concomitantly with biologics .
Based on the data presented , oral iron therapy should be preferred for patients with quiescent disease stages and trivial iron deficiency  anemia unless such patients are intolerant or have an inadequate response , whereas intravenous iron supplementation may be of advantage in patients with aggravated anemia or flares of IBD because inflammation hampers intestinal absorption of iron
Abstract Anemia is the most frequent complication of inflammatory bowel disease ( IBD ) , but anemia , mostly due to iron deficiency , has long been neglected in these patients .
The aim was to briefly present the pathophysiology , followed by a balanced overview of the different forms of iron replacement available , and subsequently , to perform a systematic review of studies performed in the last decade on the treatment of iron-deficiency anemia in IBD .
Intravenous iron therapy restores functional iron deficiency induced by infliximab.
BACKGROUND AND AIMS Infliximab ( IFX ) and iron sucrose ( FeS ) are of high value in inflammatory bowel disease ( IBD ) . We aim ed to assess the relative role of both therapies in IBD related anaemia and their safety when used in combination . METHODS IBD patients with anaemia receiving a first series of FeS infusions in addition to IFX were prospect ively followed . We investigated serum kinetics of erythropoietin ( EPO ) , soluble transferrin receptors ( sTFRs ) and vascular endothelial growth factor ( VEGF ) . RESULTS Data analysis included 87 patients of whom 49.4 % achieved the target Hb level of 12.0 g/dL.  IFX result ed in a significant increase of EPO and sTFR compared to baseline pre-IFX levels ( p=0.029 and p=0.005 respectively ) and after a 12-week combined FeS and IFX treatment , EPO and sTFR levels dropped significantly compared to pre-FeS levels ( p<0.001 for both ) . Infusion related adverse events were recorded in 2 IFX treated patients ( 2.3 % , 0.7 % of the infusions ) and were mild . Disease activity and quality of life were not affected . CONCLUSIONS In anaemic IBD patients treated with IFX  , combined administration of FeS is safe . Infliximab significantly increases serum EPO and sTFR levels result ing in an increased functional iron deficiency , which is restored after combined treatment with I.V. iron sucrose
However , in patients with IBD flares and inadequate responses to or side effects with oral preparations , intravenous iron supplementation is the therapy of choice .
Neither oral nor intravenous therapy seems to exacerbate the clinical course of IBD , and intravenous iron therapy can be administered even in active disease stages and concomitantly with biologics .
Based on the data presented , oral iron therapy should be preferred for patients with quiescent disease stages and trivial iron deficiency  anemia unless such patients are intolerant or have an inadequate response , whereas intravenous iron supplementation may be of advantage in patients with aggravated anemia or flares of IBD because inflammation hampers intestinal absorption of iron
Abstract Anemia is the most frequent complication of inflammatory bowel disease ( IBD ) , but anemia , mostly due to iron deficiency , has long been neglected in these patients .
The aim was to briefly present the pathophysiology , followed by a balanced overview of the different forms of iron replacement available , and subsequently , to perform a systematic review of studies performed in the last decade on the treatment of iron-deficiency anemia in IBD .