Anemia and IBD: Current Status and Future Prospectives

Abstract

Anemia is a common complication of inflammatory bowel disease (IBD), usually recognized at diagnosis and during flare-ups. However, the exact prevalence of anemia associated to IBD (IBD-A) is unknown. Despite its major clinical relevance and quality of life impact in both adult and pediatric IBD patients, it has been for long time neglected. It is mostly multifactorial, being a unique example of the combination of chronic iron deficiency (ID) and anemia of chronic disease (ACD). The current management of IBD-A represents a paradigm shift in clinical practice, involving several challenges. A pro-active approach is recommended and with the new generation of available iron compounds and recent guidelines, the ultimate goal will be the improvement of the patients' quality of life. Sound data are still lacking, concerning the best treatment/ prevention approach for IDA/ID. Based on current evidence, oral iron therapy might be preferred in mild IDA, whereas intravenous iron may be advantageous in more severe IDA/flaring IBD. Long-term prospective clinical trials are needed, to optimize treatment schedule and to better define the clinical and hematological long-term outcomes, both in adults and in children. They should demonstrate the efficacy, safety, and tolerance profile of different available iron formulas, as well as their cost-efficacy ratio.