Iron Metabolism Biomarkers and Hepcidin Levels in Patients with Inflammatory Bowel Disease at the University of Calabar Teaching Hospital, South South Nigeria

This study evaluates iron metabolism biomarkers including serum hepcidin, ferritin, transferrin saturation, and soluble transferrin receptor in patients with inflammatory bowel disease (IBD) at the University of Calabar Teaching Hospital, Cross River State, South South Nigeria. Iron deficiency is the most common extraintestinal complication of IBD, yet distinguishing true iron deficiency from anaemia of inflammation complicated by elevated hepcidin remains a diagnostic challenge not studied in the Nigerian IBD population. An analytical case-control study enrolled 90 IBD patients (60 Crohn's disease, 30 ulcerative colitis) and 45 healthy controls. Hepcidin was measured by ELISA. Serum iron, ferritin, TIBC, transferrin saturation, and soluble transferrin receptor were assessed. Disease activity was scored using the Harvey-Bradshaw Index and Mayo Score respectively. Hepcidin was significantly elevated in active IBD compared to controls, suppressing enteric iron absorption independently of body iron stores. Fifty-eight percent of IBD patients with low transferrin saturation had normal or elevated ferritin, a pattern masking functional iron deficiency from standard indices. Soluble transferrin receptor was the most discriminating marker between absolute iron deficiency (elevated) and anaemia of inflammation (normal) in this setting. Hepcidin correlated inversely with reticulocyte haemoglobin content. Disease activity was the strongest predictor of hepcidin elevation. The study provides a first characterisation of the iron-hepcidin axis in Nigerian IBD patients and recommends including soluble transferrin receptor and hepcidin in IBD anaemia assessments. Keywords: hepcidin, iron metabolism, inflammatory bowel disease, anaemia, Cross River State.