Abstract
Background
Strategies that consider enhancing iron absorption and reducing gastrointestinal burden are important for effective iron replacement therapy (IRT) in patients with iron deficiency anemia (IDA)
Aim
To investigate gastrointestinal tolerability, treatment compliance and iron status markers in patients with IDA who received oral IRT with versus without concomitant Lactobacillus plantarum 299v (L. plantarum 299v) probiotic supplementation
Methods
A total of 295 patients with newly diagnosed IDA who were randomly assigned to receive either IRT alone (n = 157, IRT-only group) or IRT plus L. plantarum 299v (n = 138, IRT-Pro group) were included in this prospective randomized non-placebo, controlled study. Gastrointestinal intolerance symptoms, serum hemoglobin levels and iron status markers were recorded in each group.
Results
Overall, 91 (30.8%) of 295 patients reported gastrointestinal intolerance symptoms during IRT, and 30(10.2%) discontinued IRT within the first 30 days of treatment. Patients in the IRT-Pro group compared to those in the IRT-only group experienced significantly lower rates of gastrointestinal intolerance over the course of IRT (13.0% vs. 46.5%, p < 0.001) and treatment discontinuation within the first 30 days (3.6% vs. 15.9%, p < 0.001). At 3rd month of therapy, IRT-Pro vs. IRT-only group had significantly higher serum levels for iron (76.0(51.0–96.0) vs. 60.0(43.0–70.0) µg/dL, p < 0.001) and transferrin saturation (20.1(12.5–28.5) vs. 14.5(10.5–19.0) %, p < 0.001), in addition to higher change from baseline hemoglobin (0.9(0.3–1.3) vs. 0.4(-0.1-1.1) g/dL, p < 0.001) levels.
Conclusion
Use of L. plantarum 299v probiotic supplementation during the first 30 days of IRT in IDA patients significantly reduces the gastrointestinal burden of IRT (particularly abdominal pain and bloating), the likelihood of intolerance development (by ~ 3 times) and treatment discontinuation (by ~ 5 times), as accompanied with improved serum hemoglobin levels and serum iron markers.