The role of hepcidin in the inflammatory and iron homeostasis axis in inflammatory bowel diseases: a systematic review.

Abstract

<h4>Background</h4>Inflammatory bowel disease (IBD), which encompasses Crohn's disease (CD) and ulcerative colitis (UC), is characterized by chronic inflammation of the gastrointestinal tract. Anemia is a common complication in patients with IBD, significantly impacting quality of life. Hepcidin, the primary regulator of iron metabolism, exhibits increased expression during inflammatory states, contributing to the development of anemia of inflammation. Understanding the relationship between hepcidin and IBD is essential to improving the diagnosis and management of this complication. This article aimed to systematically review and synthesize the evidence on the associative and predictive utility of hepcidin as a biomarker for inflammatory activity, iron status, and anemia management in patients with IBD.<h4>Methods</h4>A systematic review (SR) (PROSPERO identification number: CRD42024375586) was conducted across the databases PubMed, PubMed PMC, BVS/BIREME, Scopus, Web of Science, Embase, EBSCOhost, and ProQuest, including studies published up to July 2024. The research question was structured using the PICO strategy (Patient/Problem, Intervention, Comparison, and Outcome) to guide study selection and analysis. Original articles investigating hepcidin expression in patients with IBD and its association with inflammatory markers and iron status were included. Study selection, data extraction, and methodological quality assessment were performed independently by three reviewers using the Rayyan platform.<h4>Results</h4>Of the 342 studies identified, 47 met the inclusion criteria for qualitative analysis. The majority of studies reported elevated hepcidin levels in patients with active IBD compared to healthy controls or patients in remission. Hepcidin expression was positively correlated with inflammatory markers such as C-reactive protein (CRP) and interleukin-6 (IL-6), and negatively correlated with serum iron parameters and hemoglobin levels.<h4>Conclusions</h4>Hepcidin plays a central role in the pathophysiology of anemia associated with IBD, reflecting systemic inflammatory status. Its quantification may represent a valuable tool for the differential diagnosis of anemia and for guiding targeted therapies. Further longitudinal studies are required to validate its routine clinical use.