Published online Sep 28, 2018. doi: 10.3748/wjg.v24.i36.4186
Peer-review started: May 2, 2018
First decision: June 6, 2018
Revised: July 30, 2018
Accepted: August 24, 2018
Article in press: August 24, 2018
Published online: September 28, 2018
Inflammatory bowel disease (IBD) is a chronic idiopathic disease with a relapsing and remitting course. The most common extraintestinal finding seen in IBD patients is anemia, which decreases both the quality of life and the ability to work. The first study to report the incidence of anemia in Turkish patients with IBD reported that 58.2% had anemia at least once during an 18-year follow-up period.
The prevalence of anemia is higher in IBD patients than in the general population. The most common causes of anemia in IBD are iron deficiency anemia (IDA) and chronic disease anemia (CDA). Although IBD-related anemia has a relatively high prevalence, its diagnosis and treatment is generally overlooked.
The current study aimed to determine the frequency and types of anemia in IBD patients, to determine the relationship between anemia and disease characteristics, and to determine the most effective treatment approach.
This study retrospectively evaluated 465 patients who were diagnosed with IBD and followed-up between June 2015 and June 2016 in the Gastroenterology/IBD outpatient clinic or ward of Dokuz Eylül University, Medical Faculty Hospital. The IBD diagnoses were made in accordance with the new European Crohn’s and Colitis Organization (ECCO) guidelines, and were confirmed according to standard clinical, endoscopic, histologic, and radiological criteria. Demographic and clinical data as well as endoscopic activities were obtained from hospital records. We used the World Health Organization guidelines to diagnose anemia in our IBD patients. Males were diagnosed with anemia if they had hemoglobin values less than 13 g/dL, and females were diagnosed if they had hemoglobin values less than 12 g/dL. Severe anemia was defined as having Hb values below 10 g/dL for both sexes. We evaluated the lowest hemoglobin levels of each patient during follow-up, as well as iron levels and other anemia parameters. Three main classifications of anemia were selected in accordance with the European consensus on anemia in IBD, including IDA, CDA, and mixed anemia.
This study included the data from 465 IBD patients (54.6% male and 45.4% female) who were newly diagnosed or were being followed-up with in our hospital. Of these patients, 55.3% were diagnosed with CD and 44.7% with UC. Approximately fifty-two percent of the IBD patients had anemia. Anemia frequency was higher in CD than in UC. Anemia was more common among women than men. Severe anemia was observed in 21.6% of patients with CD and 9.8% of patients with UC. IDA was the most common type of anemia (29.9%).
Approximately 50.4% of all of the IBD patients who were diagnosed with anemia in this study received treatment. Of the patients with IDA, 23% received oral iron therapy and 40.3% received parenteral iron preparations. Of those with B12/folic acid anemia, 53.3% received B12/folic acid treatment. None of the patients in the current study received blood transfusions or were given erythropoiesis stimulant agents.
Since almost half of IBD patients have anemia, and because anemia causes a multitude of negative effects on patients, its presence should be further examined, and if necessary, treated with regards to disease activity. It should be kept in mind that the most common cause of anemia is iron deficiency. Treatment rates should be increased in IBD patients with anemia.
Anemia in IBD patients must be monitored throughout active and remissive disease and treated accordingly.