P1047 Moderate and severe iron deficiency anaemia responds better to oral iron therapy than mild iron deficiency anaemia in Crohn’s Disease patients: a prospective study in a resource-limited setting
Authors: Chinthala H , Dutta A K , Polavarapu J , Joseph A J , Simon E G , Chowdhury S D , Kurien R T , John A , Jaleel R , Thomas A , Abraham D , Benny B 
Published: January 2025

Abstract

Background
Iron deficiency anaemia (IDA) is the most common type of anaemia in patients with Crohn’s disease (CD). Due to the generally low absorption of oral iron, parenteral iron therapy is often the preferred treatment in these patients. However, in resource-limited countries like India, not all patients can afford the high costs and hospitalisations associated with parenteral therapy. This study aims to evaluate the effectiveness of oral iron therapy in CD patients.

Methods
Adult patients with CD presenting to our centre’s Inflammatory Bowel Disease clinic from July 2021 were screened for anaemia. Patients with IDA, defined as haemoglobin (Hb) &lt;13 g/dL in males and &lt;12 g/dL in non-pregnant females along with Transferrin saturation &lt;20% and Serum Ferritin &lt;30 µg/L or 30-100 µg/L (in the presence of elevated inflammatory markers)1, were prospectively included in this study after obtaining informed consent and Institutional review board approval (IRB no.14235). Patient demographics, disease characteristics and treatment details were noted. Anaemia was classified as mild (Hb: 10-11.9 g/dL in females and 10-12.9 g/dL in males), moderate (Hb: 7 - 9.9 g/dL) and severe (Hb: &lt;7 g/dL). Response assessment was done by measuring Hb in patients who completed oral iron therapy for a period of 8 to 12 weeks. A response was defined as an increase in follow-up Hb by ≥2 g/dL from baseline or normalisation of Hb. Chi-square test was used to assess the difference between responders and non-responders among mild versus moderate and severe anaemia.

Results
Fifty three CD patients with IDA were included. Four patients switched to parenteral iron and 4 were noncompliant to oral iron. We analysed 45 patients who completed 8 to 12 weeks of oral iron therapy. Their details are in Table 1. Of these, 35 (77.8%) patients had exclusive IDA, while 10 (22.2%) patients had IDA alongside anaemia of chronic disease. Most common symptom was weight loss, seen in 23 (51.1%) patients. Mild anaemia was seen in 18 (40%) and moderate or severe anaemia was noted in 27 (60%) patients. Most patients received oral elemental iron dosage of 50mg per day, while only 2 patients received a dosage of 100mg. Response to oral iron was seen in 25 (55.6%) patients. Patients with moderate and severe anaemia showed a more pronounced response to oral iron therapy (n=19; 70.3%) compared to those with mild anaemia (n=6; 33.3%), which was statistically significant with a p-value of 0.014. A longer follow-up and a larger number of patients will be recruited to enhance these findings in the future.

Conclusion
Our study concludes that oral iron therapy is a decent option in CD patients to improve Hb levels, predominantly in patients with moderate and severe IDA, contrary to the traditional belief.

References
1.Dignass AU, Gasche C, Bettenworth D, et al. European consensus on the diagnosis and management of iron deficiency and anaemia in inflammatory bowel diseases. J Crohns Colitis. 2015;9(3): 211-222.doi:10.1093/ecco-jcc/jjv010