Rethinking iron therapy in IBD: integrating the microbiota perspective

Area of Science:

• Gastroenterology
• Microbiology
• Hematology

Background:

• Iron deficiency and anemia are prevalent in inflammatory bowel disease (IBD).
• Oral iron therapy can negatively impact gut microbiota, potentially worsening IBD inflammation and side effects.
• Intravenous (IV) iron offers an alternative by bypassing the gastrointestinal tract.

Purpose of the Study:

• To evaluate the impact of oral versus IV iron on gut microbiota in IBD patients.
• To compare the efficacy and tolerability of different iron formulations.
• To inform treatment guidelines regarding iron supplementation in IBD.

Main Methods:

• Review of current evidence on oral and IV iron in IBD.
• Analysis of studies examining iron's effect on gut microbiota composition and function.
• Assessment of clinical outcomes, including adherence and symptom exacerbation.

Main Results:

• Oral iron can reduce beneficial bacteria and promote pro-inflammatory shifts in the gut microbiome.
• IV iron demonstrates a less disruptive effect on the gut microbiota.
• IV iron is recommended as a first-line option for IBD patients with active disease or oral intolerance.

Conclusions:

• Microbiota-conscious approaches to iron therapy are crucial for optimizing IBD management.
• IV iron is generally preferred for its improved tolerability and minimal impact on gut dysbiosis.
• Personalized iron treatment strategies considering the gut microbiome are needed for IBD patients.