Abstract Background Iron deficiency anemia (IDA) is a common complication in inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis, negatively affecting fatigue, quality of life, and clinical outcomes. Oral iron is often limited by gastrointestinal side effects and poor absorption, especially during disease flares, while intravenous (IV) iron allows rapid correction but is costlier and requires healthcare resources. Comparative data on efficacy, safety, and patient-centered outcomes remain important. Methods This prospective multicenter study included 120 consecutive IBD patients with IDA treated at tertiary centers between December 2024 and November 2025. Patients were stratified by disease activity (active flare vs remission) and received oral iron (ferrous sulfate 100–200 mg/day) or IV iron (ferric carboxymaltose). Outcomes were assessed at baseline, 4, 8, and 12 weeks, including hemoglobin, ferritin, transferrin saturation, CRP, fatigue (VAS), quality of life (IBDQ, SF-36), work productivity, adverse events, and costs. Results Among patients, 66 (55%) had Crohn’s disease and 54 (45%) ulcerative colitis; mean age 41 years, 52% female; 75% were in active disease. In active disease, IV iron increased hemoglobin by 2.6 g/dL at 8 weeks versus 1.3 g/dL with oral iron (p 0.01). In remission, IV iron increased hemoglobin by 2.2 g/dL vs 1.6 g/dL (p = 0.04). By week 12, 82% of IV iron patients achieved normalization vs 54% with oral iron. Ferritin and transferrin saturation rose faster with IV iron, and CRP declined slightly more rapidly. Fatigue and quality of life improved faster in the IV group (VAS reduction 3.1 vs 1.4, IBDQ +22 vs + 12). Gastrointestinal side effects occurred in 38% of oral iron patients versus 6% mild infusion reactions with IV iron; treatment interruptions were higher in the oral group (18% vs 2%, p 0.01). Younger patients and those with baseline hemoglobin 9 g/dL benefited most from IV iron. Direct costs for IV iron were higher, but faster anemia correction, fewer adverse events, and improved productivity may offset costs. Conclusion In conclusion, IV iron is more effective, better tolerated, and improves fatigue and quality of life faster during active IBD, while oral iron remains appropriate in remission or mild anemia. These results support individualized, patient-centered iron supplementation integrating efficacy, safety, and economic considerations. Conflict of interest: Prof. Dr. Aouroud, Meryem: No conflict of interest Aouroud, Hala: No conflict of interest Nacir, Oussama: No conflict of interest Lairani, Fatima ezzahra: No conflict of interest Ait errami, Adil: No conflict of interest Oubaha, Sofia: No conflict of interest Samlani, Zouhour: No conflict of interest Krati, Khadija: No conflict of interest
Aouroud et al. (Thu,) studied this question.