The effect of iron therapy on oxidative stress and intestinal microbiota in inflammatory bowel diseases: A review on the conundrum Original paper

What was studied?

This review article focuses on the effects of iron therapy on oxidative stress and intestinal microbiota in individuals with inflammatory bowel disease (IBD). Specifically, it investigates the relationship between iron supplementation, redox status, and the gut microbiota, examining how iron deficiency and therapy can influence disease outcomes in IBD patients. The article also highlights the clinical implications of these findings and the potential consequences of both iron deficiency and excess on the gastrointestinal system.

Who was studied?

The review synthesizes evidence from various studies, primarily involving patients with IBD, including both Crohn’s disease (CD) and ulcerative colitis (UC). These patients are often affected by iron deficiency anemia (IDA) or non-anemic iron deficiency (NAID), conditions common in IBD due to factors like chronic inflammation, malabsorption, and blood loss. The review also references studies in healthy volunteers to compare the effects of iron therapy and oxidative stress.

Most important findings

The review emphasizes that iron deficiency and iron supplementation both significantly influence oxidative stress and intestinal microbiota in IBD. Iron deficiency is associated with increased oxidative stress, while iron supplementation—especially intravenous iron—has been shown to increase oxidative stress markers and alter the microbiota. The studies reveal conflicting results on the impact of oral versus intravenous iron therapy, with oral iron generally showing less impact on oxidative stress than intravenous formulations. Notably, intravenous iron therapy is linked with increased reactive oxygen species (ROS), which could potentially exacerbate inflammation and alter the gut microbial environment. Furthermore, iron therapy, whether oral or intravenous, alters the intestinal microbiota, potentially influencing the gut’s inflammatory status. Some iron formulations may exacerbate dysbiosis, while others, such as Lactobacillus plantarum, may aid in iron absorption without significantly harming the microbiota.

Key implications

The review suggests that while iron therapy is necessary to address iron deficiency in IBD patients, its administration must be managed carefully to avoid exacerbating oxidative stress or disturbing the intestinal microbiota. Clinicians should consider low-dose or intermittent oral iron therapy in quiescent IBD and reserve intravenous iron for more severe cases. Given the observed changes in the microbiota, it’s important to further study the long-term clinical significance of these alterations and their potential effects on disease activity and patient outcomes. A personalized approach to iron therapy is recommended, factoring in the patient’s specific IBD condition, disease activity, and iron status.