Oral Iron Treatment Response and Predictors in Anaemic Adolescents and Adults with IBD: A Prospective Controlled Open-Label Trial

David S Rampton, James R Goodhand, Neerav M Joshi, Abu-Bakarr Karim, Yasmine Koodun, Farah M Barakat, Lucia Macken, Douglas G Ward, Tariq H Iqbal, Jenny Epstein, John M Fell, Ian R Sanderson

Research output: Contribution to journalArticlepeer-review


BACKGROUND: Because of previous concerns about the efficacy and safety of oral iron for treating iron deficiency anaemia in inflammatory bowel disease [IBD], particularly in young people, we compared the effects of ferrous sulphate on haemoglobin response, disease activity and psychometric scores in adolescents and adults with IBD. We also assessed the relation of baseline serum hepcidin to haemoglobin response.

METHODS: We undertook a prospective, open-label, 6-week non-inferiority trial of the effects of ferrous sulphate 200 mg twice daily on haemoglobin, iron status, hepcidin, disease activity (Harvey-Bradshaw Index, Simple Colitis Clinical Activity Index, C-reactive protein [CRP]), faecal calprotectin and psychometric scores in 45 adolescents [age 13-18 years] and 43 adults [>18 years].

RESULTS: On intention-to-treat analysis, ferrous sulphate produced similar rises in haemoglobin in adolescents {before treatment 10.3 g/dl [0.18] (mean [SEM]), after 11.7 [0.23]: p < 0.0001} and adults (10.9 g/dl [0.14], 11.9 [0.19]: p < 0.0001); transferrin saturation, ferritin [in adolescents] and hepcidin [in adults] also increased significantly. On per-protocol univariate analysis, the haemoglobin response was inversely related to baseline haemoglobin, CRP and hepcidin. Oral iron did not alter disease activity; it improved Short IBDQ and Perceived Stress Questionnaire scores in adults.

CONCLUSION: Oral ferrous sulphate was no less effective or well-tolerated in adolescents than adults, and did not increase disease activity in this short-term study. The inverse relation between baseline CRP and hepcidin levels and the haemoglobin response suggests that CRP or hepcidin measurements could influence decisions on whether iron should be given orally or intravenously. [ClinTrials.gov registration number NCT01991314].

Original languageEnglish
Pages (from-to)706-715
Number of pages10
JournalJournal of Crohn's & Colitis
Issue number6
Publication statusPublished - 1 Jun 2017
Externally publishedYes

Bibliographical note

Copyright © 2016 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com


  • Administration, Oral
  • Adolescent
  • Adult
  • Anemia, Iron-Deficiency/blood
  • Feces/chemistry
  • Female
  • Ferritins/blood
  • Ferrous Compounds/administration & dosage
  • Hemoglobins/metabolism
  • Hepcidins/blood
  • Humans
  • Inflammatory Bowel Diseases/complications
  • Intention to Treat Analysis
  • Leukocyte L1 Antigen Complex/analysis
  • Male
  • Prospective Studies
  • Quality of Life
  • Severity of Illness Index
  • Surveys and Questionnaires
  • Transferrin/metabolism


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