The burden and management of anemia in Greek patients with inflammatory bowel disease: a retrospective, multicenter, observational study

Abstract

Background Anemia is a common extraintestinal manifestation of Inflammatory Bowel Disease (IBD) affecting negatively the patients’ quality of life. The aim of this study was to determine the frequency and real-life management of anemia in IBD patients in Greece. Methods This study was conducted in 17 Greek IBD referral centers. Demographic, clinical, laboratory, IBD and anemia treatment data were collected and analyzed retrospectively. Results A total of 1394 IBD patients [560 ulcerative colitis (UC), 834 Crohn’s disease (CD)] were enrolled. Anemia at any time was reported in 687 (49.3%) patients of whom 413 (29.6%) had episodic and 274 (19.7%) had recurrent/persistent anemia. Anemia was diagnosed before IBD in 45 (6.5%), along with IBD in 269 (39.2%) and after IBD in 373 (54.3%) patients. In the multivariate analysis the presence of extraintestinal manifestations (p = 0.0008), IBD duration (p = 0.026), IBD related surgeries and hospitalizations (p = 0.026 and p = 0.004 accordingly) were risk factors of recurrent/persistent anemia. Serum ferritin was measured in 839 (60.2%) IBD patients. Among anemic patients, 535 (77.9%) received treatment. Iron supplementation was administered in 485 (90.6%) patients, oral in 142 (29.3%) and intravenous in 393 (81%). Conclusions The frequency of anemia in IBD patients, followed at Greek referral centers, is approximately 50%. Development of recurrent/persistent anemia may be observed in 20% of cases and is independently associated with the presence of extraintestinal manifestations, IBD duration, IBD related surgeries and hospitalizations. Anemia treatment is administered in up to $$4/5$$ 4 / 5 of anemia IBD patients with the majority of them receiving iron intravenously.

Iron Deficiency Anemia in Inflammatory Bowel Diseases—A Narrative Review

“…According to the World Health Organization (WHO), it can be defined as hemoglobin level <13 g/dL in men or <12 g/dL in non-pregnant women [8][9][10]. The European Crohn's and Colitis Organisation (ECCO) guidelines classify anemia in IBD patients as iron deficiency anemia (IDA), anemia of chronic disease (ACD), and B12 or folic acid deficiency-associated anemia [8,11]. However, it is noteworthy that since IBD patients present with concomitant chronic intestinal bleeding, inflammation and ulcerations, impaired absorption, malnutrition, the toxic effects of medications, and undergo surgical procedures, the exact etiology of anemia cannot be determined.…”

“…However, it is noteworthy that since IBD patients present with concomitant chronic intestinal bleeding, inflammation and ulcerations, impaired absorption, malnutrition, the toxic effects of medications, and undergo surgical procedures, the exact etiology of anemia cannot be determined. Pathogenesis is usually multifactorial [11]. Table 1 shows the most common pathomechanisms of anemia in IBD patients.…”

“…On the other hand, in the Inflammatory Bowel in South Eastern Norway cohort (IBSEN) study by Hoivik et al, which included 756 IBD patients at diagnosis and at the 1-, 5-and 10-year follow-ups, it was reported that 48.8% of newly diagnosed CD patients and 20.2% UC patients presented with anemia upon diagnosis. A total of 6.5% of patients had anemia more than 1 year prior to IBD diagnosis, while 13% of CD patients and 7.5% of UC patients presented with anemia 10 years from diagnosis [11,16,17]. In a systemic review and meta-analysis, including 2192 patients, Filmann et al found that the overall incidence of anemia in IBD patients was 24%, and of severe anemia, 2.75%.…”

FERALGINE™ a New Oral iron Compound

“…The same consensus paper underlines as IV iron is more effective, shows a faster response, and is better tolerated than oral iron [37]. However although new IV iron formulations have proved to be bettertolerated and lead to a faster Hb rise than oral iron, there is still hesitancy among gastroenterologists to promote this administration due to its risk of hypersensitivity reactions [38]. The results obtained by Vernero et al on IBD patients highlight as FBC-A is effective and well tolerated in subjects with intestinal mucosa lesions who generally are poor responders to oral iron treatment and have reduced compliance.…”

“…On the other hand, about 7.9% that received iron intravenously experienced adverse events during infusion. The availability of a well absorbed oral compound with good tolerability would be of great benefit for these patients, avoiding the need of intravenous treatment [38].…”