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

Abstract

Background and aimsAnaemia affects up to 74% patients with Crohn's disease (CD) and ulcerative colitis (UC) and is correlated with decreased quality of life. The European Crohn's and Colitis Organisation (ECCO) recommends at least annual screening for iron-deficiency anaemia. We aimed to determine the prevalence of anaemia, frequency of anaemia screening and factors associated with anaemia in a retrospective study of mild to moderate inflammatory bowel disease (IBD) in the USA.MethodsAdults with at least two outpatient encounters for IBD between 2010 through 2014 who contributed laboratory information were identified from MarketScan, a US commercial claims database. Hospitalised patients were considered severe and excluded from the study. WHO criteria defined anaemia. Iron-deficiency anaemia was evaluated using ferritin and C reactive protein.ResultsThe eligible population included 17 059 adults, 43.9% with CD. During the 2-year median follow-up period, 68.1% of patients with CD and 65.3% of patients with UC were screened for anaemia. The prevalence of anaemia among those screened was 32.4% in CD and 27.6% in UC. Among 669 persons with sufficient information, 79.2% of those with CD and 85.1% of those with UC had iron-deficiency anaemia. Factors associated with anaemia were similar for those with CD and UC and included ≥6 IBD-related outpatient visits, female sex, age and smoking.ConclusionsMore than 30% of patients with IBD in the USA were not screened for anaemia during a 2-year period. Approximately 82% of anaemic patients were iron deficient, although the absence of ferritin results limited the findings. Incorporation of screening for anaemia and, in particular, iron deficiency, should be a component of international treatment guidelines.

The Tumor Necrosis Factor Superfamily Members TNFSF14 (LIGHT), Lymphotoxin β and Lymphotoxin β Receptor Interact to Regulate Intestinal Inflammation

“…Inflammatory bowel disease affects over 1.5 million Americans, and effective treatment options for this debilitating autoimmune disorder are lacking ( 21 ). While anti-TNF therapies have proved efficacious in certain patient populations, more therapeutic approaches are clearly needed ( 22 ).…”

Diet and inflammatory bowel disease: The Asian Working Group guidelines

“…Risk factors for anemia included extensive disease in case of UC and penetrating or colonic disease in case of CD. In a study, from the USA, which included 17,059 adults with IBD, the prevalence of anemia was 32.4% in CD and 27.6% in UC [ 139 ]. It was attributed to iron deficiency in 79.2% of those with CD and 85.1% of those with UC.…”

“…Patients with IBD are at increased risk of micronutrient deficiency (including folate, iron, magnesium, vitamin B 12 , calcium, phosphate) due to reduced intake of nutrients secondary to anorexia, malabsorption (inflamed mucosa or short bowel after surgical resection), increased losses (fistulae, exudation in gastrointestinal tract), and effect of drugs used in the treatment of IBD [ 158 , 159 ]. Iron deficiency is the most common cause of anemia in IBD patients [ 138 , 139 , 160 ]. In addition to reduced intake due to anorexia and increased GI losses, impaired iron metabolism contributes to an iron deficient state in IBD.…”

Clinical codes combined with procedure codes increase diagnostic accuracy of Crohn’s disease in a US military health record

“…Previous studies of accuracy of diagnostic codes in the USA found that 67.5% of patients with CD were correctly classified based on at least one ICD-9-CM 555 encounter3 and 88% with two encounters 4. Some cohorts have not performed their own validation studies; rather, they have relied on a case definition of two encounters based on prior evidence 5–10. One study showed a positive predictive value (PPV) of 91% when a CD code was present without any UC codes, although this appears to be an outlier 11.…”