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Serum Hepcidin and Iron Absorption in Paediatric Inflammatory Bowel Disease
Massimo Martinelli1, Caterina Strisciuglio2, Annalisa Alessandrella1
1Department of Translational Medical Science, Section of Paediatrics, University of Naples Federico II, Naples, Italy.
Insights
Serum hepcidin is elevated in children with active inflammatory bowel disease (IBD), correlating with disease severity and contributing to iron malabsorption. This finding highlights hepcidin
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Immunology
Background:
- Inflammatory Bowel Disease (IBD) encompasses chronic inflammatory conditions of the gastrointestinal tract in children.
- Hepcidin, a key regulator of iron metabolism, plays a role in various inflammatory conditions.
- Understanding iron homeostasis is crucial for managing IBD in pediatric populations.
Purpose of the Study:
- To investigate the correlation between serum hepcidin levels and disease activity in pediatric IBD patients.
- To assess the relationship between hepcidin, inflammatory markers, and iron load tests (ILT).
- To compare hepcidin levels in IBD patients with those in children with celiac disease and healthy controls.
Main Methods:
- A cross-sectional study involving 145 children: 50 with IBD, 45 with celiac disease, and 50 healthy controls.
- Comprehensive laboratory assessments including complete blood count, iron status, erythropoiesis parameters, serum hepcidin, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR).
- Iron load test (ILT) performed in IBD patients to evaluate iron absorption; disease activity indices, duration, localization, therapy, and fecal calprotectin were also assessed.
Main Results:
- Serum hepcidin levels were significantly higher in active IBD patients compared to celiac and healthy controls (p = 0.005, p = 0.003).
- Active disease (Pediatric Crohn's Disease Activity Index/Pediatric Ulcerative Colitis Activity Index ≥ 30) was independently associated with elevated serum hepcidin (OR = 6.87).
- Patients with iron malabsorption (IM) exhibited higher ESR, CRP, and hepcidin levels, and were more likely to have active disease (p = 0.01).
Conclusions:
- Serum hepcidin is elevated in children with active IBD.
- Increased hepcidin levels are associated with disease activity and contribute to iron malabsorption in pediatric IBD.
- Hepcidin may serve as a biomarker for disease activity and iron dysregulation in pediatric IBD.
Background And Aims:
We sought to correlate hepcidin levels in inflammatory bowel disease [IBD] children with disease activity, inflammatory markers, and iron load test [ILT] and to compare IBD patients with coeliac and healthy patients.
Methods:
Between December 2012 and June 2013, 145 subjects [50 IBD patients, 45 coeliac patients and 50 healthy controls] were included in the study. All patients underwent the following examinations: blood count, iron status, erythropoiesis parameters, serum hepcidin, C-reactive protein [CRP], and erythrocyte sedimentation rate [ESR]. In order to evaluate the efficacy of iron absorption, ILT was performed in IBD patients. Disease activity indexes and IBD duration, localisation, and therapy were also evaluated, and a faecal sample for calprotectin collected.
Results:
Serum hepcidin was significantly higher in IBD patients with active disease compared with both coeliac and healthy patients [p = 0.005, p = 0.003 respectively]. In a multivariate logistic regression model, having a Paediatric Crohn's Disease Activity Index [PCDAI] / Paediatric Ulcerative Colitis Activity Index [PUCAI] ≥ 30 resulted in the only variable independently associated with a positive serum hepcidin (odds ratio [OR] = 6.87; 95% confidence interval [CI] 1.4-33, p = 0.01]]. Patients with iron malabsorption [IM] showed higher values of ESR, CRP, and hepcidin [p = 0.02, p = 0.001, and p = 0.06, respectively]. Eight out of 12 [66.7%] children with IM showed an active disease compared with 6/31 [19.3%] children with normal ILT [p = 0.01]. Hepcidin levels correlated negatively with ILT [r = -0.451, p = 0.002], and positively with ferritin and CRP [r = 0.442, p = 0.0001; r = 0.243, p = 0.009, respectively]
Conclusions:
Our study demonstrates that serum hepcidin is increased in IBD children with active disease and it is responsible for IM.
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