Goldberg Neil D
Emeritus Chief of Gastroenterology, University of Maryland St. Joseph Medical Center, Towson, MD, USA.
Clin Exp Gastroenterol. 2013 Jun 4;6:61-70. doi: 10.2147/CEG.S43493. Print 2013.
Iron deficiency anemia is the most common form of anemia worldwide, caused by poor iron intake, chronic blood loss, or impaired absorption. Patients with inflammatory bowel disease (IBD) are increasingly likely to have iron deficiency anemia, with an estimated prevalence of 36%-76%. Detection of iron deficiency is problematic as outward signs and symptoms are not always present. Iron deficiency can have a significant impact on a patient's quality of life, necessitating prompt management and treatment. Effective treatment includes identifying and treating the underlying cause and initiating iron replacement therapy with either oral or intravenous iron. Numerous formulations for oral iron are available, with ferrous fumarate, sulfate, and gluconate being the most commonly prescribed. Available intravenous formulations include iron dextran, iron sucrose, ferric gluconate, and ferumoxytol. Low-molecular weight iron dextran and iron sucrose have been shown to be safe, efficacious, and effective in a host of gastrointestinal disorders. Ferumoxytol is the newest US Food and Drug Administration-approved intravenous iron therapy, indicated for iron deficiency anemia in adults with chronic kidney disease. Ferumoxytol is also being investigated in Phase 3 studies for the treatment of iron deficiency anemia in patients without chronic kidney disease, including subgroups with IBD. A review of the efficacy and safety of iron replacement in IBD, therapeutic considerations, and recommendations for the practicing gastroenterologist are presented.
缺铁性贫血是全球最常见的贫血形式，由铁摄入不足、慢性失血或吸收受损引起。炎症性肠病（IBD）患者患缺铁性贫血的可能性越来越大，估计患病率为36%-76%。由于外在体征和症状并不总是存在，缺铁的检测存在问题。缺铁会对患者的生活质量产生重大影响，因此需要及时管理和治疗。有效的治疗包括识别和治疗潜在病因，并开始口服或静脉注射铁剂进行铁替代治疗。有多种口服铁剂配方可供选择，富马酸亚铁、硫酸亚铁和葡萄糖酸亚铁是最常用的处方铁剂。可用的静脉制剂包括右旋糖酐铁、蔗糖铁、葡萄糖酸铁和 ferumoxytol。低分子量右旋糖酐铁和蔗糖铁已被证明在许多胃肠道疾病中是安全、有效且高效的。Ferumoxytol是美国食品药品监督管理局最新批准的静脉铁剂疗法，适用于患有慢性肾病的成人缺铁性贫血。Ferumoxytol也正在进行3期研究，用于治疗无慢性肾病的缺铁性贫血患者，包括患有IBD的亚组。本文综述了IBD中铁替代治疗的疗效和安全性、治疗考虑因素以及对执业胃肠病学家的建议。
