Prevalence of Anemia in Inflammatory Bowel Diseases in European Countries

Filmann, Natalie; Rey, Julia; Schneeweiss, Sven; Ardizzone, Sandro; Bager, Palle; Bergamaschi, Gaetano; Koutroubakis, Ioannis E.; Lindgren, Stefan; Morena, Felipe de la; Moum, Bjørn; Vavricka, Stephan R.; Schröder, Oliver; Herrmann, Eva; Blumenstein, Irina

doi:10.1097/01.mib.0000442728.74340.fd

Cited by 145 publications

(89 citation statements)

References 26 publications

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“…We confirmed that despite significant beneficial effects on disease activity and clinical outcomes, anti-TNF therapy had only a modest effect on patients’ Hb levels. We found that the prevalence of anemia in IBD patients who start anti-TNF treatment was 38.1% which is similar to other reports on the prevalence of anemia in IBD (21–23). It is especially important to note that one year after the initiation of anti-TNF therapy, the prevalence of anemia remained unchanged at 36.6% despite the initiation of potent anti-inflammatory treatment and the iron supplementation.…”

Section: Discussionsupporting

confidence: 90%

The Influence of Anti–tumor Necrosis Factor Agents on Hemoglobin Levels of Patients with Inflammatory Bowel Disease

Koutroubakis

Ramos-Rivers

Regueiro

et al. 2015

Inflammatory Bowel Diseases

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Background Anti-tumor necrosis factor (TNF) agents are an important component of inflammatory bowel disease (IBD) treatment but data on their influence on anemia, a frequent complication of IBD is limited. The aim of this study was to evaluate the effect of anti-TNF agents on hemoglobin (Hb) levels in a large IBD cohort. Methods Prospectively collected demographic, clinical, laboratory and treatment data from IBD patients who started anti-TNF treatment at a tertiary referral center during the years 2010–2012 were analyzed. Follow-up data including disease activity scores (Harvey-Bradshaw Index or ulcerative colitis activity index), quality of life scores [short IBD questionnaire (SIBDQ)] completed at each visit, and laboratory data were analyzed. Data from the year of anti-TNF initiation (year 0) and the following year (year 1) were compared. Results A total of 430 IBD patients (324 with Crohn’s disease, 51.6% females) started anti-TNF treatment. The prevalence of anemia and median Hb levels did not change between year 0 and year 1. Median SIBDQ was significantly improved at year 1 (p=0.002). IBD patients with anemia had significantly higher median Hb levels at year 1 compared to year 0 (p=0.0009). Hematopoietic response (increase of Hb ≥2 g/dL) was observed in only 33.6 % of the 134 anemic IBD patients, despite iron replacement being administered in 126 anemic patients (oral 77 %). Improvement in Hb levels was independently significantly correlated with change of CRP levels (p=0.04) and immunomodulators use (p=0.03). Conclusion Anemia remains a significant manifestation of IBD one year after treatment with anti-TNF agents.

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Section: Discussionsupporting

confidence: 90%

The Influence of Anti–tumor Necrosis Factor Agents on Hemoglobin Levels of Patients with Inflammatory Bowel Disease

Koutroubakis

Ramos-Rivers

Regueiro

et al. 2015

Inflammatory Bowel Diseases

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“…This prevalence is slightly higher than that published recently in a meta-analysis by Filmann et al: 24% of 2,192 European patients with IBD had anemia [7]. Other studies show that up to 68% of inpatients with IBD had anemia [8,9].…”

Section: Discussionmentioning

confidence: 68%

Prevalence of Anemia and Iron Deficiency in Romanian Patients with Inflammatory Bowel Disease: a Prospective Multicenter Study

Lupu

Diculescu

Diaconescu

et al. 2015

JGLD

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Background & Aims: Anemia is the most frequent systemic complication in inflammatory bowel diseases. It affects the quality of life and can interact with working capacity. Our objectives were to identify the prevalence of anemia, its main causes and its management in patients with inflammatory bowel disease from Romania.Methods: We conducted a multicenter prospective study from March 2013 to August 2014. We enrolled 291 patients from three referral centers: 115 (39.52%) with Crohn's disease (CD) and 176 (60.48%) with ulcerative colitis (UC). We defined anemia according to the WHO criteria.Results: Median age of the patients was 41 years and the median time period since diagnosis was 3 years (0.75-7). The median activity index for UC (UCAI) was 4 and the median CD activity index (CDAI) was 96. More patients with CD were on antiTNFα therapy (p < 0.01), corticosteroids (p =0.18) or azathioprine (p=0.05) and required surgery for their underlying disease at study enrollment (p < 0.01). Anemia was present in 31.27% of the patients, more often in those with CD (35.65%) than with UC (28.41%) (not statistically significant); 53.26% of the patients had iron deficiency while 4.12% had folic acid and 8.59% vitamin B12 deficiency; 9.62% of the patients had received anti-anemic therapy at inclusion in the study or in the last three months prior to study enrollment.Conclusions: About one in three Romanian patients with inflammatory bowel disease has anemia, which is frequently associated with iron deficiency. About 30% of the patients with anemia are under therapy and the most frequent route for iron supplementation is the oral one. This might contribute to the high prevalence of iron deficiency and the low level of compliance.

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“…Over half of the IBD patients were found to have anemia at least once during their follow-up. Recent studies conducted mostly in Europe, report that the point prevalence of anemia in IBD is between 20 and 40% (10,11). However, there is no data regarding the period prevalence in large cohorts of IBD patients.…”

Section: Discussionmentioning

confidence: 99%

“…The prevalence of anemia appears to be lower in outpatients when compared to hospitalized IBD patients (10). A recent meta-analysis of European studies with 2192 patients, mainly treated in tertiary referral centers, showed an overall prevalence of anemia of 27% [95% confidence interval (CI), 19–35] for Crohn’s disease (CD) and 21% (95% CI, 15–27) for ulcerative colitis (UC) (11). Most existing data describes point prevalence, whereas the period prevalence of anemia in IBD patients is largely unknown.…”

Section: Introductionmentioning

confidence: 99%

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

Koutroubakis

Ramos-Rivers

Regueiro

et al. 2016

Journal of Clinical Gastroenterology

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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.

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Prevalence of Anemia in Inflammatory Bowel Diseases in European Countries

Abstract: The overall prevalence of anemia in patients with Crohn's disease was 27% (95% confidence interval, 19-35) and 21% (95% confidence interval, 15-27) in patients with ulcerative colitis. Thereby, 57% of the anemic patients were iron deficient.

Cited by 145 publications

References 26 publications

The Influence of Anti–tumor Necrosis Factor Agents on Hemoglobin Levels of Patients with Inflammatory Bowel Disease

The Influence of Anti–tumor Necrosis Factor Agents on Hemoglobin Levels of Patients with Inflammatory Bowel Disease

Prevalence of Anemia and Iron Deficiency in Romanian Patients with Inflammatory Bowel Disease: a Prospective Multicenter Study

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

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