Retrospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 28, 2018; 24(36): 4186-4196
Published online Sep 28, 2018. doi: 10.3748/wjg.v24.i36.4186
Frequency, types, and treatment of anemia in Turkish patients with inflammatory bowel disease
Göksel Bengi, Hatice Keyvan, Seda Bayrak Durmaz, Hale Akpınar
Göksel Bengi, Hale Akpınar, Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Dokuz Eylül University, İzmir 35360, Turkey
Hatice Keyvan, Seda Bayrak Durmaz, Department of Internal Medicine, Faculty of Medicine, Dokuz Eylül University, İzmir 35360, Turkey
Author contributions: Bengi G, Keyvan H, Durmaz SB, and Akpınar H contributed equally to this work, designed the research, drafted the manuscript, and provided administrative and technical support.
Institutional review board statement: This study was approved by the Dokuz Eylul University Ethics Committee in June 2017.
Informed consent statement: Informed consent was provided by all participants.
Conflict-of-interest statement: The authors have declared no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Göksel Bengi, MD, PhD, Assistant Professor, Department of Gastroenterology, Dokuz Eylul University Hospital, İnciraltı, İzmir 35000, Turkey. goksel.bengi@deu.edu.tr
Telephone: +90-532-4626972 Fax: +90-232-4123799
Received: May 2, 2018
Peer-review started: May 2, 2018
First decision: June 6, 2018
Revised: July 30, 2018
Accepted: August 24, 2018
Article in press: August 24, 2018
Published online: September 28, 2018
Abstract
AIM

To specify the type and prevalence of anemia along with a treatment approach for inflammatory bowel disease (IBD).

METHODS

We conducted a retrospective study on 465 patients who were diagnosed with IBD and followed up at our hospital from June 2015 to June 2016 [male: 254, female: 211; average age: 47 ± 14.4; Crohn’s disease (CD): 257, Ulcerative Colitis (UC): 208]. Epidemiological and clinical data, such as sex, age, age of diagnosis, type of IBD, disease extension, disease behavior and duration, treatments for IBD and anemia, and surgical history were obtained for each patient. Per World Health Organization guidelines, anemia was diagnosed for males if hemoglobin values were less than 13 g/dL and for females if hemoglobin values were less than 12 g/dL.

RESULTS

We determined that 51.6% of the patients had anemia, which was more frequent in women then men (64% vs 41.3%, P < 0.001). Anemia frequency was higher in CD cases (57.6%) than in UC cases (44.2%) (P = 0.004). CD involvements were as follows: 48.2% in ileal involvement, 19% in colonic involvement, and 32.8% in ileocolonic involvement. Furthermore, 27.5% of UC patients had proctitis (E1) involvement, 41% of them had involvement in left colitis (E2), and 31.5% had pancolitis involvement. There was no significant relationship between anemia frequency and duration of disease (P = 0.55). Iron deficiency anemia (IDA) was the most common type of anemia in this cohort. Moreover, because anemia parameters have not been evaluated during follow-up of 15.3% of patients, the etiology of anemia has not been clarified. Fifty percent of patients with anemia received treatment. Twenty-three percent of IDA patients had oral iron intake and forty-one percent of IDA patients had parenteral iron treatment. Fifty-three percent of patients who were suffering from megaloblastic anemia received B12/folic acid treatment.

CONCLUSION

We found out that almost half of all IBD patients (51.6%) had anemia, the most frequent of which was IDA. Almost half of these patients received treatment. We should increase the treatment rate in our IBD patients that have anemia.

Keywords: Anemia, Inflammatory bowel disease, Anemia of iron deficiency

Core tip: We conducted a retrospective study on 465 patients, who were diagnosed with inflammatory bowel disease (IBD). We determined that 51.6% of patients had anemia, which was more frequent in women then men. Anemia frequency was higher in Crohn’s disease cases than in ulcerative colitis cases. No relation has been found between the presence of anemia and disease duration. Iron deficiency anemia was the most common type of anemia. The factors that are related to anemia among IBD patients are being female, drug therapy (corticosteroids, AZA/MTX, Anti-TNF), and high C-reactive protein levels. Fifty percent of patients with anemia received treatment.