Ferrous Fumarate Deteriorated Plasma Antioxidant Status in Patients with Crohn Disease

Erichsen, Kari; Hausken, Trygve; Ulvik, Rune J.; Svardal, Asbjørn; Berstad, Arnold; Berge, Rolf K.

doi:10.1080/00365520310000771

Cited by 76 publications

(72 citation statements)

References 20 publications

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“…Here we contribute safety and efficacy data for IV iron therapy in pediatric IBD. Oral ferrous supplements are oxidized in the gut, produce activated hydroxyl radicals that affect the mucosa [18] and may provoke gastrointestinal symptoms including bloating, nausea and pain which can be exacerbated in patients with IBD [19]. In inflammatory diseases, iron absorption is reduced and increased hepcidin, an acute phase protein, plays a key role.…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of parenteral iron in children with inflammatory bowel disease

Papadopoulos

Patel

Korologou-Linden³

et al. 2018

Brit J Clinical Pharma

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Objectives: Iron deficiency anemia (IDA) frequently complicates inflammatory bowel disease (IBD) in children and adults. Oral iron may exacerbate gastrointestinal symptoms and absorption may be insufficient in intestinal inflammation. Even where oral iron is successful, repletion of iron stores can be unacceptably slow. Intravenous (IV) iron compounds were in the past associated with serious adverse reactions and historically were considered a last resort in children. New generation preparations have a safer profile in adults although reluctance to use them in children may persist, where safety data is lacking. We investigate the safety and efficacy of ferric carboxymaltose (FCM) and iron sucrose (IS) in children. Methods:We retrospectively identified all children with IBD who received parenteral iron over a 38 month period in a single regional referral centre. Safety, tolerability and adverse events were established by case note review. Efficacy was assessed by change in hematinic indices pre-and posttreatment.Results: 47 children (18 male; median age 14yrs, range 3-17) received a total of 104 iron infusions. 44% (21) had Crohn's disease (CD); 56% (27) ulcerative colitis (UC). 40 received FC, eight IS and one both. Three children developed mild rash post infusion which resolved quickly with chlorphenamine. Mean increase in hemoglobin (Hb) was 2.5g/dl (0.3-5.8). Iron levels increased by a mean of 8.4 g/dl (1-25), transfer in saturation by 16.2% (2-47). Transfer in decreased by 0.84 g/dl (0.3-3.4). Conclusion:New generation parenteral iron preparations are safe, well tolerated and efficacious in children with IDA and IBD.What is known: Iron deficiency anemia (IDA) is a common complication of inflammatory bowel disease (IBD) and a significant contributor to morbidity.IDA should be actively treated in IBD.Parenteral iron is effective and relatively safe in adults. What is new:The intravenous iron preparations ferric carboxymaltose (FCM) and iron sucrose (IS) are effective treatments for IDA in children with IBD. The safety profiles of FCM and IS are favourable, and similar in children to that in adults.

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Section: Discussionmentioning

confidence: 99%

Safety and efficacy of parenteral iron in children with inflammatory bowel disease

Papadopoulos

Patel

Korologou-Linden³

et al. 2018

Brit J Clinical Pharma

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“…Although formal prospective studies do not exist it is generally accepted that Fe deficiency (ID) is common in CD (Gasche et al 1994(Gasche et al , 1997Harvey et al 1998;Mamula et al 2002;Erichsen et al 2003). This is based upon (a) frequent clinical observations; (b) retrospective analysis and audit of patient notes (Child et al 1973;Thomson et al 1978;Gasche et al 1994;De Silva et al 2001a,b;Oldenburg et al 2001); (c) response to oral or intravenous Fe therapy (Gasche et al 1997(Gasche et al , 2001Harvey et al 1998).…”

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confidence: 99%

Intake of dietary iron is low in patients with Crohn's disease: a case–control study

et al. 2004

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Patients with Crohn's disease (CD) often experience Fe deficiency (ID) and frequently alter their diet to relieve abdominal symptoms. The present study set out to assess whether patients with CD have dietary habits that lead to low Fe intakes and/or reduced bioavailable Fe compared with control subjects. Patients with asymptomatic CD were matched to controls (n91/group). Dietary intakes of Fe and contributions from different food groups were compared using a 7 d food diary. Promoters and inhibitors of non-haem Fe absorption were investigated and a recently published algorithm was applied to assess bioavailable Fe. Fewer patients than controls met the reference nutrient intake for Fe (32 % CD patientsv. 42 % controls). Overall, patients had significantly lower mean Fe intakes (by 2·3 mg/d) and Fe density (by 0·26 mg/MJ (1·1 mg/1000 kcal)) compared with controls (bothP<0·001). Differences were mainly due to a preference among CD patients for low-fibre non-Fe fortified cereals, particularly breakfast cereals. In particular, control subjects had higher Fe intakes than matched CD subjects for men (P<0·001) and women less than 50 years (P=0·03). Intakes of both ascorbic acid (P<0·001) and phytic acid (P<0·01), but not animal tissue (P=1·0), were lower in patients with CD, but these had no overall effect on the predicted percentage of bioavailable Fe. Thus total bioavailable Fe was reduced in patients with CD due to lower intakes (P<0·01). Dietary Fe intakes are low in CD patients, which may contribute to an increased risk of ID and anaemia. Changing dietary advice may compromise perceived symptoms of the disease so the need for Fe supplementation should be carefully considered.

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“…Furthermore, studies in animal models have demonstrated that luminal iron that is not absorbed can cause damage by oxidative stress and exacerbate bowel inflammation. 93 Absolute indications for intravenous therapy should be considered: (1) moderate to severe anaemia (haemoglobin < 10.5 g/dL) or clearly symptomatic anaemia; (2) previous intolerance to oral iron supplements; (3) inappropriate response to oral iron; (4) active severe intestinal disease; (5) need for a quick therapeutic response (e.g. surgery in the short term); (6) concomitant therapy with erythropoiesis-stimulating agent; and (7) patient's preference.…”

Section: Rationalementioning

confidence: 99%

Portuguese Consensus on the Diagnosis, Prevention and Treatment of Anaemia in Inflammatory Bowel Disease

et al. 2016

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Introduction: Anaemia can be considered the most common extra-intestinal manifestation in inflammatory bowel disease. Nevertheless, anaemia is often under-diagnosed and under-treated both in adults and children with inflammatory bowel disease. Herein, we report the consensus statements on the management of anaemia in inflammatory bowel disease developed by the Portuguese Working Group on Inflammatory Bowel Disease (known as Grupo de Estudo da Doença Inflamatória Intestinal - GEDII) to aid clinicians in daily management of inflammatory bowel disease patients. Material and Methods: A comprehensive literature review was conducted in order to prepare consensus statements on the following topics: (1) prevalence and diagnosis of anaemia in inflammatory bowel disease, (2) iron supplementation for the prevention of anaemia in inflammatory bowel disease and (3) treatment of anaemia in inflammatory bowel disease. The final statements for each topic were discussed at a consensus meeting and rated according to the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence. Consensus: It was concluded that anaemia has a high incidence and prevalence in inflammatory bowel disease, particularly in those with active disease and hospitalised. Patients with anaemia had decreased quality of life and frequently complained of fatigue. Absolute indications for intravenous therapy should be considered: (1) moderate to severe anaemia (haemoglobin < 10.5 g/dL) or clearly symptomatic anaemia; (2) previous intolerance to oral iron supplements; (3) inappropriate response to oral iron; (4) active severe intestinal disease; (5) need for a quick therapeutic response (e.g. surgery in the short term); (6) concomitant therapy with erythropoiesis-stimulating agent; and (7) patient’s preference.

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Ferrous Fumarate Deteriorated Plasma Antioxidant Status in Patients with Crohn Disease

Abstract: Treatment of iron deficiency with ferrous fumarate deteriorated plasma antioxidant status and increased specific clinical symptoms in patients with active Crohn disease. Plasma reduced cysteine may be a sensitive indicator for oxidative stress in the intestine.

Cited by 76 publications

References 20 publications

Safety and efficacy of parenteral iron in children with inflammatory bowel disease

Safety and efficacy of parenteral iron in children with inflammatory bowel disease

Intake of dietary iron is low in patients with Crohn's disease: a case–control study

Portuguese Consensus on the Diagnosis, Prevention and Treatment of Anaemia in Inflammatory Bowel Disease

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