Hemochromatosis: a clinical guideline from the American College of Gastroenterology

  • Kowdley KV & al.
  • Am J Gastroenterol
  • 22 Jul 2019

  • International Clinical Digest
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Takeaway

  • Phlebotomy remains the most important treatment for hereditary hemochromatosis (HH), but emerging therapies may have a role for some patients, according to a new clinical guideline from the American College of Gastroenterology.

Why this matters

  • HH is 1 of the most common genetic disorders affecting people with northern European ancestry, resulting in excess iron in tissues and organs.

Key recommendations

  • Family members of patients with HH should also receive screening.
  • Phlebotomy should be the first-line HH treatment.
    • Exceptions:
      • Patients intolerant of or refractory to treatment.
      • Patients who might be harmed because they have severe anemia or congestive heart failure.
    • Recommended treatment for these patients is iron chelation.
  • Proton pump inhibitors (PPIs) should not be used routinely as the primary HH treatment.
  • Liver transplant referral should be considered for patients with HH who also have end-stage liver disease or hepatocellular carcinoma.

Limitations

  • Quality of evidence for iron chelation, PPI, and liver transplant recommendations is low; further research is very likely to affect the confidence in estimates of clinical effect.