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Iron deficiency in inflammatory bowel disease

The underestimated adversary
PhD ceremony:Ms R. (Roberta) Loveikyte
When:April 17, 2024
Supervisor:prof. dr. G. Dijkstra
Co-supervisor:dr. A.E. van der Meulen-de Jong
Where:Academy building RUG
Faculty:Medical Sciences / UMCG
Iron deficiency in inflammatory bowel disease

Iron deficiency in inflammatory bowel disease

Inflammatory Bowel Disease (IBD)—encompassing Crohn’s disease and ulcerative colitis—is a chronic immune-mediated condition characterized by a relapsing-remitting inflammation of the gastrointestinal tract. The primary treatment goal is to treat and prevent inflammation, complications, and disease progression; however, recent advancements in therapeutic options enabled physicians to also strive for long-term goals: restoring quality of life and ensuring the absence of disability. These goals include the management of conditions, such as anemia, iron deficiency, and fatigue.

In this thesis, we assessed the prevalence of anemia among outpatients with IBD in 16 Dutch hospitals and we observed that one in five outpatients had anemia, most commonly caused by iron deficiency. IBD disease activity remains one of the main risk factors for anemia and iron deficiency in this population. In addition, we observed that screening for iron deficiency was not always performed, explaining why some patients received untargeted iron supplementation and others did not receive it at all. Consequently, we emphasize the need to raise awareness among medical professionals.

Furthermore, we explored the diagnostic and therapeutic utility of a new biomarker hepcidin—a protein that regulates iron absorption and systemic availability—to improve and personalize treatment of iron deficiency and anemia. We found that hepcidin levels varied greatly in patients and healthy control subjects. The levels were primarily determined by iron status, even in an inflammatory state. In addition, we observed that an oral iron absorption test together with hepcidin could differentiate among different types of acquired or inherited anemia and guide further diagnostic and therapeutic decision-making. In this thesis, we also describe an ongoing clinical trial, which assesses whether hepcidin levels before oral or intravenous iron therapy can predict response to it. When completed, this trial will provide the necessary data to personalize iron therapy.

Finally, we describe a clinical trial which showed that, compared to standard care, a multimodal lifestyle intervention improved fatigue by approximately 12% in addition to improvements in disease perception and acceptance of the health status.