Prevalence and treatment of anemia in inflammatory bowel disease in a Colombian reference center
DOI:
https://doi.org/10.22516/25007440.696Keywords:
Anemia, Inflammatory Bowel disease, Prevalence, Parenteral IronAbstract
Introduction: Anemia is the most frequent complication of inflammatory bowel disease (IBD). This study aims to determine the prevalence, connection, and treatment of anemia in IBD in a local context.
Materials and Methods: This retrospective study was conducted at The Pablo Tobon Uribe Hospital, in Medellín (Colombia) with adult patients who (were admitted) came for consultation from 2001, until February 2019. Absolut and relative frequencies were calculated. The Chi square test of independence was applied for comparing two proportions and the odds ratio (OR) was estimated.
Results: A total of 759 IBD patients were enrolled, 544 (71.6%) with ulcerative colitis (UC); 200 (26.3%) Crohn’s disease (CD), and 15 (1.9%) with non-classifiable IBD. In total, 185 (24,4 %) IBD patients had a diagnosis of anemia, that is less frequent in UC patients that in CD patients (22,2 % versus 32,5 %, respectively; OR: 0,684; CI: 0,456-0,96; p = 0,03). Extensive UC patients (54,1 %) had a more recurrent level of anemia than non-extensive UC (46,3 %) (OR: 4,4; CI: 2,6-7,4; p = 0,001); the same result was observed when severe UC (66,1 %) was compared with UC non-severe (32,3 %) (OR: 4,95; CI: 2,87-8,51; p = 0,000). In the analysis of CD, patients with a non-inflammatory response (B2, B3: 73,9 %) had a more recurrent level of anemia than patients with an inflammatory response (B1: 26,2 %) (OR: 0,35; CI: 0,18-0,67; p = 0,000). 44,3 % of the total number of patients received treatment, 19,5 % received oral iron, 20,0 % received intravenous iron, and 16,2 % received a blood transfusion.
Conclusions: In our context, Anemia is a common complication in IBD cases (24,4 %). Despite the existence of international guidelines, the treatment in our context is not optimal
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Dignass AU, Gasche C, Bettenworth D, Birgegård G, Danese S, Gisbert JP, Gomollon F, Iqbal T, Katsanos K, Koutroubakis I, Magro F, Savoye G, Stein J, Vavricka S; European Crohn’s and Colitis Organisation [ECCO]. European consensus on the diagnosis and management of iron deficiency and anaemia in inflammatory bowel diseases. J Crohns Colitis. 2015;9(3):211-22. https://doi.org/10.1093/ecco-jcc/jju009
Koutroubakis IE, Ramos-Rivers C, Regueiro M, Koutroumpakis E, Click B, Schoen RE, Hashash JG, Schwartz M, Swoger J, Baidoo L, Barrie A, Dunn MA, Binion DG. Persistent or Recurrent Anemia Is Associated With Severe and Disabling Inflammatory Bowel Disease. Clin Gastroenterol Hepatol. 2015;13(10):1760-6. https://doi.org/10.1016/j.cgh.2015.03.029
Wells CW, Lewis S, Barton JR, Corbett S. Effects of changes in hemoglobin level on quality of life and cognitive function in inflammatory bowel disease patients. Inflamm Bowel Dis. 2006;12(2):123-30. https://doi.org/10.1097/01.MIB.0000196646.64615.db
González Alayón C, Pedrajas Crespo C, Marín Pedrosa S, Benítez JM, Iglesias Flores E, Salgueiro Rodríguez I, Medina Medina R, García-Sánchez V. Prevalence of iron deficiency without anaemia in inflammatory bowel disease and impact on health-related quality of life. Gastroenterol Hepatol. 2018;41(1):22-29. https://doi.org/10.1016/j.gastrohep.2017.07.011
Gasche C. Anemia in IBD: the overlooked villain. Inflamm Bowel Dis. 2000;6(2):142-150. https://doi.org/10.1097/00054725-200005000-00013
WHO U, UNU. Iron Deficiency Anemia: Assessment, Prevention and Control. Report of a Joint WHO/UNICEF/UNU Consultation. Geneva, Switzerland: World Health Organization 2001. Disponible en: https://www.who.int/nutrition/publications/en/ida_assessment_prevention_control.pdf
Stein J, Hartmann F, Dignass AU. Diagnosis and management of iron deficiency anemia in patients with IBD. Nat Rev Gastroenterol Hepatol. 2010;7(11):599-610. https://doi.org/10.1038/nrgastro.2010.151
Oustamanolakis P, Koutroubakis IE, Kouroumalis EA. Diagnosing anemia in inflammatory bowel disease: beyond the established markers. J Crohns Colitis. 2011;5(5):381-91. https://doi.org/10.1016/j.crohns.2011.03.010
Kulnigg S, Gasche C. Systematic review: managing anaemia in Crohn’s disease. Aliment Pharmacol Ther. 2006;24(11-12):1507-23. https://doi.org/10.1111/j.1365-2036.2006.03146.x
Gisbert JP, Gomollón F. Common misconceptions in the diagnosis and management of anemia in inflammatory bowel disease. Am J Gastroenterol. 2008;103(5):1299-307. https://doi.org/10.1111/j.1572-0241.2008.01846.x
Kotze PG, Underwood FE, Damião AOMC, Ferraz JGP, Saad-Hossne R, Toro M, Iade B, Bosques-Padilla F, Teixeira FV, Juliao-Banos F, Simian D, Ghosh S, Panaccione R, Ng SC, Kaplan GG. Progression of Inflammatory Bowel Diseases Throughout Latin America and the Caribbean: A Systematic Review. Clin Gastroenterol Hepatol. 2020;18(2):304-312. https://doi.org/10.1016/j.cgh.2019.06.030
Antunes CV, Hallack Neto AE, Nascimento CR, Chebli LA, Moutinho IL, Pinheiro Bdo V, Reboredo MM, Malaguti C, Castro AC, Chebli JM. Anemia in inflammatory bowel disease outpatients: prevalence, risk factors, and etiology. Biomed Res Int. 2015;2015:728925. https://doi.org/10.1155/2015/728925
Parra RS, Feitosa MR, Ferreira SDC, Rocha JJRD, Troncon LEA, FÉres O. Anemia and iron deficiency in inflammatory bowel disease patients in a referral center in brazil: prevalence and risk factors. Arq Gastroenterol. 2020;57(3):272-277. https://doi.org/10.1590/S0004-2803.202000000-51
Gasche C, Berstad A, Befrits R, Beglinger C, Dignass A, Erichsen K, Gomollon F, Hjortswang H, Koutroubakis I, Kulnigg S, Oldenburg B, Rampton D, Schroeder O, Stein J, Travis S, Van Assche G. Guidelines on the diagnosis and management of iron deficiency and anemia in inflammatory bowel diseases. Inflamm Bowel Dis. 2007;13(12):1545-53. https://doi.org/10.1002/ibd.20285
Reinisch W, Staun M, Bhandari S, Muñoz M. State of the iron: how to diagnose and efficiently treat iron deficiency anemia in inflammatory bowel disease. J Crohns Colitis. 2013;7(6):429-40. https://doi.org/10.1016/j.crohns.2012.07.031
Truelove Sc, Witts LJ. Cortisone in ulcerative colitis; final report on a therapeutic trial. Br Med J. 1955;2(4947):1041-8. https://doi.org/10.1136/bmj.2.4947.1041
Silverberg MS, Satsangi J, Ahmad T, Arnott ID, Bernstein CN, Brant SR, Caprilli R, Colombel JF, Gasche C, Geboes K, Jewell DP, Karban A, Loftus EV Jr, Peña AS, Riddell RH, Sachar DB, Schreiber S, Steinhart AH, Targan SR, Vermeire S, Warren BF. Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. Can J Gastroenterol. 2005;19 Suppl A:5A-36A. https://doi.org/10.1155/2005/269076
Filmann N, Rey J, Schneeweiss S, Ardizzone S, Bager P, Bergamaschi G, Koutroubakis I, Lindgren S, Morena Fde L, Moum B, Vavricka SR, Schröder O, Herrmann E, Blumenstein I. Prevalence of anemia in inflammatory bowel diseases in european countries: a systematic review and individual patient data meta-analysis. Inflamm Bowel Dis. 2014;20(5):936-45. https://doi.org/10.1097/01.MIB.0000442728.74340.fd
Høivik ML, Reinisch W, Cvancarova M, Moum B; IBSEN study group. Anaemia in inflammatory bowel disease: a population-based 10-year follow-up. Aliment Pharmacol Ther. 2014;39(1):69-76. https://doi.org/10.1111/apt.12541
Sjöberg D, Holmström T, Larsson M, Nielsen AL, Holmquist L, Rönnblom A. Anemia in a population-based IBD cohort (ICURE): still high prevalence after 1 year, especially among pediatric patients. Inflamm Bowel Dis. 2014;20(12):2266-70. https://doi.org/10.1097/MIB.0000000000000191
Burisch J, Vegh Z, Katsanos KH, Christodoulou DK, Lazar D, Goldis A, et al; EpiCom study group. Occurrence of Anaemia in the First Year of Inflammatory Bowel Disease in a European Population-based Inception Cohort-An ECCO-EpiCom Study. J Crohns Colitis. 2017;11(10):1213-1222. https://doi.org/10.1093/ecco-jcc/jjx077
Stein J, Bager P, Befrits R, Gasche C, Gudehus M, Lerebours E, Magro F, Mearin F, Mitchell D, Oldenburg B, Danese S. Anaemia management in patients with inflammatory bowel disease: routine practice across nine European countries. Eur J Gastroenterol Hepatol. 2013;25(12):1456-63. https://doi.org/10.1097/MEG.0b013e328365ca7f
Blumenstein I, Dignass A, Vollmer S, Klemm W, Weber-Mangal S, Stein J. Current practice in the diagnosis and management of IBD-associated anaemia and iron deficiency in Germany: the German AnaemIBD Study. J Crohns Colitis. 2014;8(10):1308-14. https://doi.org/10.1016/j.crohns.2014.03.010
Bager P, Befrits R, Wikman O, Lindgren S, Moum B, Hjortswang H, Dahlerup JF. The prevalence of anemia and iron deficiency in IBD outpatients in Scandinavia. Scand J Gastroenterol. 2011;46(3):304-9. https://doi.org/10.3109/00365521.2010.533382
D’Amico F, Peyrin-Biroulet L, Danese S. Oral Iron for IBD Patients: Lessons Learned at Time of COVID-19 Pandemic. J Clin Med. 2020;9(5):1536. https://doi.org/10.3390/jcm9051536
Juliao F, Agudelo Y, Yepes C. Variación en el cuidado de pacientes con Enfermedad Inflamatoria Intestinal (EII): resultado de una encuesta. Rev Col Gastroenterol. 2014;29(1):11-18.
Lugg S, Beal F, Nightingale P, Bhala N, Iqbal T. Iron treatment and inflammatory bowel disease: what happens in real practice? J Crohns Colitis. 2014;8(8):876-80. https://doi.org/10.1016/j.crohns.2014.01.011
Patel D, Yang YX, Trivedi C, Kavani H, Xie D, Medvedeva E, Lewis J, Khan N. Incidence, Duration, and Management of Anemia: A Nationwide Comparison Between IBD and Non-IBD Populations. Inflamm Bowel Dis. 2020;26(6):934-940. https://doi.org/10.1093/ibd/izz206
Danese S, Hoffman C, Vel S, Greco M, Szabo H, Wilson B, Avedano L. Anaemia from a patient perspective in inflammatory bowel disease: results from the European Federation of Crohn’s and Ulcerative Colitis Association’s online survey. Eur J Gastroenterol Hepatol. 2014;26(12):1385-91. https://doi.org/10.1097/MEG.0000000000000200
Hou JK, Gasche C, Drazin NZ, Weaver SA, Ehrlich OG, Oberai R, Zapala S, Siegel CA, Melmed G. Assessment of Gaps in Care and the Development of a Care Pathway for Anemia in Patients with Inflammatory Bowel Diseases. Inflamm Bowel Dis. 2017;23(1):35-43. https://doi.org/10.1097/MIB.0000000000000953
Qureshi T, Peter Nguyen T, Wang R, Willis D, Shah R, Hou JK. Improving Anemia in Inflammatory Bowel Disease: Impact of the Anemia Care Pathway. Dig Dis Sci. 2019;64(8):2124-2131. https://doi.org/10.1007/s10620-019-05559-w
Peyrin-Biroulet L, Lopez A, Cummings JRF, Dignass A, Detlie TE, Danese S. Review article: treating-to-target for inflammatory bowel disease-associated anaemia. Aliment Pharmacol Ther. 2018;48(6):610-617. https://doi.org/10.1111/apt.14922

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