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DOI: 10.1055/s-0031-1273324
© Georg Thieme Verlag KG Stuttgart · New York
Diagnose und Behandlung von Eisenmangel und Anämie bei chronisch entzündlichen Darmerkrankungen. Konsensus der österreichischen Arbeitsgruppe für CED
Diagnosis and Treatment of Iron Deficiency and Anaemia in Inflammatory Bowel Diseases. Consensus of the Austrian IBD Working PartyPublikationsverlauf
Manuskript eingetroffen: 2.12.2010
Manuskript akzeptiert: 15.3.2011
Publikationsdatum:
27. April 2011 (online)

Zusammenfassung
Eisenmangel mit und ohne Anämie ist ein häufiges Problem bei Patienten mit chronisch entzündlichen Darmerkrankungen (CED) und kann mit einer erheblichen Einschränkung der Lebensqualität und Leistungsfähigkeit verbunden sein. Die Arbeitsgruppe für CED der Österreichischen Gesellschaft für Gatroenterologie und Hepatologie (ÖGGH) erarbeitete 5 Konsensus-Statements zu folgenden Inhalten: Diagnose von Eisenmangel und Anämie, Screening auf Eisenmangel, Behandlung von Eisenmangel und Behandlungsziele. Die klinische Bedeutung der intravenösen Eisensubstitution bei CED in Bezug auf Effektivität und Compliance wurde diskutiert.
Abstract
Iron deficiency with and without anAemia is a common burden of patients with inflammatory bowel diseases (IBD) and has considerable impact on their quality of life and the ability to perform. The IBD working group of the Austrian Society of Gastroenterology and Hepatology developed five consensus statements on the following topics: (i) diagnosis of iron deficiency and (ii) anaemia, (iii) screening of iron deficiency, (iv) treatment of iron deficiency and (v) therapeutic goals. The clinical importance of intravenous iron replacement therapy in IBD with regard to effectiveness and compliance was discussed.
Schlüsselwörter
Colitis ulcerosa - extraintestinale Manifestation - Morbus Crohn - chronisch entzündliche Darmerkrankung - Eisenmangel
Key words
ulcerative colitis - extraintestinal manifestations - Crohn’s disease - inflammatory bowel disease - Iron deficiency
Literatur
- 1
Gasche C.
Anemia in IBD: the overlooked villain.
Inflamm Bowel Dis.
2000;
6
142-150
MissingFormLabel
- 2
Gasche C, Lomer M C, Cavill I et al.
Iron, anaemia, and inflammatory bowel diseases.
Gut.
2004;
53
1190-1197
MissingFormLabel
- 3
Kulnigg S, Gasche C.
Systematic review: managing anaemia in Crohn’s disease.
Aliment Pharmacol Ther.
2006;
24
1507-1523
MissingFormLabel
- 4
Wilson A, Reyes E, Ofman J.
Prevalence and outcomes of anemia in inflammatory bowel disease: a systematic review
of the literature.
Am J Med.
2004;
116 (Suppl 7A)
44S-9S
MissingFormLabel
- 5
Weiss G, Gasche C.
Pathogenesis and treatment of anemia in inflammatory bowel disease.
Haematologica.
2010;
95
175-178
MissingFormLabel
- 6
Gasche C, Berstad A, Befrits R et al.
Guidelines on the diagnosis and management of iron deficiency and anemia in inflammatory
bowel diseases.
Inflamm Bowel Dis.
2007;
13
1545-1553
MissingFormLabel
- 7 WHO, UNICEF, and UNU .Iron Deficiency Anemia: Assessment, Prevention and Control. Report of a joint WHO/UNICEF/UNU
consultation. Geneva: World Health Organization; 1998 Conference Proceeding
MissingFormLabel
- 8
Blanc B, Finch C A, Hallberg L et al.
Nutritional anaemias. Report of a WHO Scientific Group.
WHO Tech Rep Ser.
1968;
405
1-40
MissingFormLabel
- 9
Beutler E, Waalen J.
The definition of anemia: what is the lower limit of normal of the blood hemoglobin
concentration?.
Blood.
2006;
107
1747-1750
MissingFormLabel
- 10
Beutler E, Felitti V J, Koziol J A et al.
Penetrance of 845G → A (C282Y) HFE hereditary haemochromatosis mutation in the USA.
Lancet.
2002;
359
211-218
MissingFormLabel
- 11
Waalen J, Felitti V, Gelbart T et al.
Penetrance of hemochromatosis.
Blood Cells Mol Dis.
2002;
29
418-432
MissingFormLabel
- 12
Hollowell J G, Assendelft O W, Gunter E W et al.
Hematological and iron-related analytes – reference data for persons aged 1 year and
over: United States, 1988 – 94.
Vital Health Stat.
2005;
11
1-156
MissingFormLabel
- 13
Gomollon van F, Gisbert J P.
Anemia and inflammatory bowel diseases.
World J Gastroenterol.
2009;
15
4659-4665
MissingFormLabel
- 14
Weiss G, Goodnough L T.
Anemia of chronic disease.
N Engl J Med.
2005;
352
1011-1023
MissingFormLabel
- 15
Semrin G, Fishman D S, Bousvaros A et al.
Impaired intestinal iron absorption in Crohn’s disease correlates with disease activity
and markers of inflammation.
Inflamm Bowel Dis.
2006;
12
1101-1106
MissingFormLabel
- 16
Nemeth E, Tuttle M S, Powelson J et al.
Hepcidin regulates cellular iron efflux by binding to ferroportin and inducing its
internalization.
Science.
2004;
306
2090-2093
MissingFormLabel
- 17
Theurl I, Aigner E, Theurl M et al.
Regulation of iron homeostasis in anemia of chronic disease and iron deficiency anemia:
diagnostic and therapeutic implications.
Blood.
2009;
113
5277-5286
MissingFormLabel
- 18
Busbridge M, Griffiths C, Ashby D et al.
Development of a novel immunoassay for the iron regulatory peptide hepcidin.
Br J Biomed Sci.
2009;
66
150-157
MissingFormLabel
- 19
Hansen T M, Hansen N E, Birgens H S et al.
Serum ferritin and the assessment of iron deficiency in rheumatoid arthritis.
Scand J Rheumatol.
1983;
12
353-359
MissingFormLabel
- 20
Bartels U, Pedersen N S, Jarnum S.
Iron absorption and serum ferritin in chronic inflammatory bowel disease.
Scand J Gastroenterol.
1978;
13
649-656
MissingFormLabel
- 21
Schaefer R M, Schaefer L.
Hypochromic red blood cells and reticulocytes.
Kidney Int Suppl.
1999;
69
S44-S48
MissingFormLabel
- 22
Bermejo F, Garcia-Lopez S.
A guide to diagnosis of iron deficiency and iron deficiency anemia in digestive diseases.
World J Gastroenterol.
2009;
15
4638-4643
MissingFormLabel
- 23
Devalia V.
Diagnosing vitamin B-12 deficiency on the basis of serum B-12 assay.
BMJ.
2006;
333
385-386
MissingFormLabel
- 24
Bruner A B, Joffe A, Duggan A K et al.
Randomised study of cognitive effects of iron supplementation in non-anaemic iron-deficient
adolescent girls.
Lancet.
1996;
348
992-996
MissingFormLabel
- 25
Erichsen K, Hausken T, Ulvik R J et al.
Ferrous fumarate deteriorated plasma antioxidant status in patients with Crohn disease.
Scand J Gastroenterol.
2003;
38
543-548
MissingFormLabel
- 26
Erichsen K, Ulvik R J, Grimstad T et al.
Effects of ferrous sulphate and non-ionic iron-polymaltose complex on markers of oxidative
tissue damage in patients with inflammatory bowel disease.
Aliment Pharmacol Ther.
2005;
22
831-838
MissingFormLabel
- 27
De Silva A D, Tsironi E, Feakins R M et al.
Efficacy and tolerability of oral iron therapy in inflammatory bowel disease: a prospective,
comparative trial.
Aliment Pharmacol Ther.
2005;
22
1097-1105
MissingFormLabel
- 28
Seril D N, Liao J, West A B et al.
High-iron diet: foe or feat in ulcerative colitis and ulcerative colitis-associated
carcinogenesis.
J Clin Gastroenterol.
2006;
40
391-397
MissingFormLabel
- 29
Werner T, Wagner S J, Martinez I et al.
Depletion of luminal iron alters the gut microbiota and prevents Crohn’s disease-like
ileitis.
Gut.
2011;
60
325-333
MissingFormLabel
- 30
Silva A D, Tsironi de E, Feakins R M et al.
Efficacy and tolerability of oral iron therapy in inflammatory bowel disease: a prospective,
comparative trial.
Aliment Pharmacol Ther.
2005;
22
1097-1105
MissingFormLabel
- 31
Rimon E, Kagansky N, Kagansky M et al.
Are we giving too much iron? Low-dose iron therapy is effective in octogenarians.
Am J Med.
2005;
118
1142-1147
MissingFormLabel
- 32
Zlotkin S, Arthur P, Antwi K Y et al.
Randomized, controlled trial of single versus 3-times-daily ferrous sulfate drops
for treatment of anemia.
Pediatrics.
2001;
108
613-616
MissingFormLabel
- 33
Schreiber S, Howaldt S, Schnoor M et al.
Recombinant erythropoietin for the treatment of anemia in inflammatory bowel disease.
The New England Journal of Medicine.
1996;
334
619-623
MissingFormLabel
- 34
Schroder O, Mickisch O, Seidler U et al.
Intravenous iron sucrose versus oral iron supplementation for the treatment of iron
deficiency anemia in patients with inflammatory bowel disease – a randomized, controlled,
open-label, multicenter study.
Am J Gastroenterol.
2005;
100
2503-2509
MissingFormLabel
- 35
Kulnigg S, Stoinov S, Simanenkov V et al.
A novel intravenous iron formulation for treatment of anemia in inflammatory bowel
disease: the ferric carboxymaltose (FERINJECT) randomized controlled trial.
Am J Gastroenterol.
2008;
103
1182-1192
MissingFormLabel
- 36
Lindgren S, Wikman O, Befrits R et al.
Intravenous iron sucrose is superior to oral iron sulphate for correcting anaemia
and restoring iron stores in IBD patients: A randomized, controlled, evaluator-blind,
multicentre study.
Scand J Gastroenterol.
2009;
44 (7)
838-895
MissingFormLabel
- 37
Bayraktar U D, Bayraktar S.
Treatment of iron deficiency anemia associated with gastrointestinal tract diseases.
World J Gastroenterol.
2010;
16
2720-2725
MissingFormLabel
- 38
Wells C W, Lewis S, Barton J R et al.
Effects of changes in hemoglobin level on quality of life and cognitive function in
inflammatory bowel disease patients.
Inflamm Bowel Dis.
2006;
12
123-130
MissingFormLabel
- 39
Gisbert J P, Gomollon F.
Common misconceptions in the diagnosis and management of anemia in inflammatory bowel
disease.
Am J Gastroenterol.
2008;
103
1299-1307
MissingFormLabel
- 40
Kulnigg S, Teischinger L, Dejaco C et al.
Rapid recurrence of IBD-associated anemia and iron deficiency after intravenous iron
sucrose and erythropoietin treatment.
Am J Gastroenterol.
2009;
104
1460-1467
MissingFormLabel
- 41
Evstatiev R, Marteau P, Iqbal T et al.
Efficacy and safety of standardised ferric carboxymaltose doses vs. individually calculated
iron sucrose doses for IBD-associated iron deficiency anaemia: A multicentre, randomised
controlled trial.
Gut.
2010;
59
A-5075
MissingFormLabel
- 42
Koutroubakis I E, Oustamanolakis P, Karakoidas C et al.
Safety and Efficacy of Total-Dose Infusion of Low Molecular Weight Iron Dextran for
Iron Deficiency Anemia in Patients with Inflammatory Bowel Disease.
Dig Dis Sci.
2010;
55 (8)
2327-2331
MissingFormLabel
- 43
Lyseng-Williamson K A, Keating G M.
Ferric carboxymaltose: a review of its use in iron-deficiency anaemia.
Drugs.
2009;
69
739-756
MissingFormLabel
- 44
Ganzoni A M.
Intravenous iron-dextran: therapeutic and experimental possibilities.
Schweiz Med Wochenschr.
1970;
100
301-303
MissingFormLabel
- 45
Ali M, Rigolosi R, Fayemi A O et al.
Failure of serum ferritin levels to predict bone-marrow iron content after intravenous
iron-dextran therapy.
Lancet.
1982;
1
652-655
MissingFormLabel
- 46
Besarab A, Bolton W K, Browne J K et al.
The effects of normal as compared with low hematocrit values in patients with cardiac
disease who are receiving hemodialysis and epoetin.
N Engl J Med.
1998;
339
584-590
MissingFormLabel
- 47
Locatelli F, Pisoni R L, Combe C et al.
Anaemia in haemodialysis patients of five European countries: association with morbidity
and mortality in the Dialysis Outcomes and Practice Patterns Study (DOPPS).
Nephrol Dial Transplant.
2004;
19
121-132
MissingFormLabel
- 48
Michael B, Coyne D W, Fishbane S et al.
Sodium ferric gluconate complex in hemodialysis patients: adverse reactions compared
to placebo and iron dextran.
Kidney Int.
2002;
61
1830-1839
MissingFormLabel
- 49
Auerbach M, Ballard H, Glaspy J.
Clinical update: intravenous iron for anaemia.
Lancet.
2007;
369
1502-1504
MissingFormLabel
- 50
Chertow G M, Mason P D, Vaage-Nilsen O et al.
Update on adverse drug events associated with parenteral iron.
Nephrol Dial Transplant.
2006;
21
378-382
MissingFormLabel
- 51
Bailie G R, Clark J A, Lane C E et al.
Hypersensitivity reactions and deaths associated with intravenous iron preparations.
Nephrol Dial Transplant.
2005;
20
1443-1449
MissingFormLabel
- 52
Weiss G, Gordeuk V R.
Benefits and risks of iron therapy for chronic anaemias.
Eur J Clin Invest.
2005;
35 (Suppl 3)
36-45
MissingFormLabel
- 53
Sazawal S, Black R E, Ramsan M et al.
Effects of routine prophylactic supplementation with iron and folic acid on admission
to hospital and mortality in preschool children in a high malaria transmission setting:
community-based, randomised, placebo-controlled trial.
Lancet.
2006;
367
133-143
MissingFormLabel
- 54
Carrier J, Aghdassi E, Platt I et al.
Effect of oral iron supplementation on oxidative stress and colonic inflammation in
rats with induced colitis.
Aliment Pharmacol Ther.
2001;
15
1989-1999
MissingFormLabel
- 55
Seril D N, Liao J, Ho K L et al.
Dietary iron supplementation enhances DSS-induced colitis and associated colorectal
carcinoma development in mice.
Dig Dis Sci.
2002;
47
1266-1278
MissingFormLabel
- 56
Seril D N, Liao J, Yang C S et al.
Systemic iron supplementation replenishes iron stores without enhancing colon carcinogenesis
in murine models of ulcerative colitis: comparison with iron-enriched diet.
Dig Dis Sci.
2005;
50
696-707
MissingFormLabel
- 57
Carrier J, Aghdassi E, Cullen J et al.
Iron supplementation increases disease activity and vitamin E ameliorates the effect
in rats with dextran sulfate sodium-induced colitis.
J Nutr.
2002;
132
3146-3150
MissingFormLabel
- 58
Kabat G C, Miller A B, Jain M et al.
A cohort study of dietary iron and heme iron intake and risk of colorectal cancer
in women.
Br J Cancer.
2007;
97
118-122
MissingFormLabel
- 59
Cross A J, Gunter M J, Wood R J et al.
Iron and colorectal cancer risk in the alpha-tocopherol, beta-carotene cancer prevention
study.
Int J Cancer.
2006;
118
3147-3152
MissingFormLabel
- 60
Senesse P, Meance S, Cottet V et al.
High dietary iron and copper and risk of colorectal cancer: a case-control study in
Burgundy, France.
Nutr Cancer.
2004;
49
66-71
MissingFormLabel
- 61
Kato I, Dnistrian A M, Schwartz M et al.
Iron intake, body iron stores and colorectal cancer risk in women: a nested case-control
study.
Int J Cancer.
1999;
80
693-698
MissingFormLabel
- 62
Seril D N, Liao J, West A B et al.
High-iron diet: foe or feat in ulcerative colitis and ulcerative colitis-associated
carcinogenesis.
J Clin Gastroenterol.
2006;
40
391-397
MissingFormLabel
- 63
Lakatos L, Mester G, Erdelyi Z et al.
Risk factors for ulcerative colitis associated colorectal cancers in a Hungarian cohort
of ulcerative colitis patients.
Orv Hetil.
2006;
147
175-181
MissingFormLabel
- 64
Stein J, Hartmann F, Dignass A U.
Diagnosis and management of iron deficiency anemia in patients with IBD.
Nat Rev Gastroenterol Hepatol.
2010;
7
599-610
MissingFormLabel
Dr. Christoph Gasche
KIM3, Abt. für Gastroenterologie und Hepatologie
Währinger Gürtel 18 – 20
1090 Wien
Österreich
eMail: christoph.gasche@meduniwien.ac.at