Five-Year Period Prevalence and Characteristics of Anemia in a Large US Inflammatory Bowel Disease Cohort

Abstract

Background Anemia is a common manifestation of inflammatory bowel disease (IBD) but its prevalence in the U.S. is not well defined. Aim of this study was to determine the prevalence and characteristics of anemia in IBD patients who were followed in a U.S. referral center. Methods Demographic, clinical, laboratory and treatment data from a prospective, consented longitudinal IBD registry between the years 2009-2013 were analyzed. Disease activity was evaluated using Harvey-Bradshaw index (HBI) in Crohn’s disease (CD) and ulcerative colitis (UC) activity index (UCAI) in UC as well as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Anemia was defined based on the World Health Organization criteria. Results A total of 1821 IBD patients [1077 with CD, 744 with UC, median age 43.8 years, 51.9% female] were included. The 5-year period prevalence of anemia in IBD patients was 50.1%, (CD: 53.3% vs UC: 44.7%, P =0.001). In multivariate logistic regression analysis anemia was associated with surgery for IBD [odds ratio (OR) 2.77 95% confidence inderval (CI) (2.21-3.48) P<0.0001)], female gender (OR 1.29 95% CI 1.04-1.61 P=0.02), CRP (OR 1.26 95%CI 1.16-1.37 P<0.0001), ESR (OR 1.02 95%CI 1.01-1.03 P=0.0002) and use of biologics (OR 2.00 95%CI 1.58-2.52 P=0.0001) or immunomodulators (OR 1.51 95%CI 1.21-1.87 P=0.0003). Iron replacement therapy was administered to 46.8% of the anemic patients. Conclusions Anemia has a high period prevalence in IBD patients followed at a tertiary center. Anemia is more common in CD than in UC, is associated with disease activity and in current practice is undertreated.

Prevalence and screening for anaemia in mild to moderate Crohn's disease and ulcerative colitis in the United States, 2010–2014

“…Furthermore, only 12 studies have examined the prevalence of anaemia or its treatments outside of Europe including a total of 2839 patients predominately in single-centre studies conducted in the USA. 4 16 23 33 …”

Prevalence of iron deficiency anemia and iron deficiency in a pediatric population with inflammatory bowel disease

“…The true prevalence of iron deficiency (ID) and IDA in the pediatric population is unknown. In recent studies, Goodhand et al and later Danko estimated it to be up to 70% at diagnosis and even after two years of follow-up prevalence can be as high as 30% [2,[4][5][6][7][8][9][10].…”

“…Therefore, it is important to carefully evaluate iron status of all patients so that ID and IDA can be diagnosed and treated timely [7,8].…”

Iron and inflammation – the gut reaction

“…It occurs as the sole form of anemia in about 15% of anemic IBD patients, and in combination with iron deficiency anemia in 35–40% of such individuals. 49,50 Several studies have examined serum or urine hepcidin concentrations in patients with IBD in order to shed light on the pathogenesis of the associated anemia. 51–56 The results generally demonstrate that hepcidin levels are elevated in the patients relative to healthy controls and that they correlate with disease activity and serum ferritin concentrations.…”