Hepcidin Patterns Among IBD Patients

June 2, 2026

Issue 11

Clinical Question

What is the association between hepcidin, iron status and inflammatory activity in inflammatory bowel disease?

Editor’s Bottom Line

Hepcidin is a key regulator of iron homeostasis and a novel biomarker for both iron status and systemic inflammation, with different patterns in Crohn’s disease vs. ulcerative colitis.

Reference

Magro F, Ministro P, de Sousa HT, et al. Distinct hepcidin patterns in Crohn’s disease and ulcerative colitis: links to iron homeostasis and inflammatory activity. J Crohn’s Colitis. Epub ahead of print March 10, 2026. https://doi:10.1093/ecco-jcc/jjag023

Synopsis

This multicenter cross-sectional study evaluated the relationship between hepcidin, iron status and inflammatory markers in 178 healthy controls, 130 patients with ulcerative colitis (UC), and 281 patients with Crohn’s disease (CD). Participants were stratified by iron status using both European Crohn’s and Colitis Organization (ECCO) criteria and a combined ferritin and transferrin saturation definition, and by disease activity using clinical and biomarker-based measures.

Hepcidin levels were highest in CD patients, followed by UC and controls, with a significant difference between CD and controls (p=0.031).

In UC, hepcidin was negatively correlated with fecal calprotectin (FCAL) (p <0.001), while no significant correlation was observed with C-reactive protein (CRP). Higher FCAL levels were associated with lower hepcidin concentrations.

In CD, hepcidin was positively correlated with CRP (p=0.038), while no significant association was observed with FCAL. Patients with CRP ≥3 mg/L had higher hepcidin levels than those with lower CRP (p=0.011). Multivariable regression analysis confirmed that FCAL was negatively associated with hepcidin in UC, while CRP ≥3 mg/L was positively associated with hepcidin in CD.

Serum hepcidin was strongly correlated with serum ferritin across all subgroups (p<0.001). Receiver operating characteristic analysis identified hepcidin cut-offs for detecting iron deficiency without anemia of 5.128 ng/mL in UC (Area Under the Curve=0.798) and 5.702 ng/mL in CD (AUC=0.758) using ECCO criteria. Within the same iron status strata, CD patients also had higher hepcidin levels than controls (p=0.023).

Details

Study Design: Multicenter cross-sectional observational study
Funding: Portuguese Inflammatory Bowel Disease Study Group; Vifor Pharma
Allocation: No randomization
Setting: Multicenter
Level of Evidence: 2b