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
Processing time: 146 Days and 15.8 Hours
ARTICLE HIGHLIGHTS
Research background

Inflammatory bowel disease (IBD) is a chronic idiopathic disease with a relapsing and remitting course. The most common extraintestinal finding seen in IBD patients is anemia, which decreases both the quality of life and the ability to work. The first study to report the incidence of anemia in Turkish patients with IBD reported that 58.2% had anemia at least once during an 18-year follow-up period.

Research motivation

The prevalence of anemia is higher in IBD patients than in the general population. The most common causes of anemia in IBD are iron deficiency anemia (IDA) and chronic disease anemia (CDA). Although IBD-related anemia has a relatively high prevalence, its diagnosis and treatment is generally overlooked.

Research objectives

The current study aimed to determine the frequency and types of anemia in IBD patients, to determine the relationship between anemia and disease characteristics, and to determine the most effective treatment approach.

Research methods

This study retrospectively evaluated 465 patients who were diagnosed with IBD and followed-up between June 2015 and June 2016 in the Gastroenterology/IBD outpatient clinic or ward of Dokuz Eylül University, Medical Faculty Hospital. The IBD diagnoses were made in accordance with the new European Crohn’s and Colitis Organization (ECCO) guidelines, and were confirmed according to standard clinical, endoscopic, histologic, and radiological criteria. Demographic and clinical data as well as endoscopic activities were obtained from hospital records. We used the World Health Organization guidelines to diagnose anemia in our IBD patients. Males were diagnosed with anemia if they had hemoglobin values less than 13 g/dL, and females were diagnosed if they had hemoglobin values less than 12 g/dL. Severe anemia was defined as having Hb values below 10 g/dL for both sexes. We evaluated the lowest hemoglobin levels of each patient during follow-up, as well as iron levels and other anemia parameters. Three main classifications of anemia were selected in accordance with the European consensus on anemia in IBD, including IDA, CDA, and mixed anemia.

Research results

This study included the data from 465 IBD patients (54.6% male and 45.4% female) who were newly diagnosed or were being followed-up with in our hospital. Of these patients, 55.3% were diagnosed with CD and 44.7% with UC. Approximately fifty-two percent of the IBD patients had anemia. Anemia frequency was higher in CD than in UC. Anemia was more common among women than men. Severe anemia was observed in 21.6% of patients with CD and 9.8% of patients with UC. IDA was the most common type of anemia (29.9%).

Approximately 50.4% of all of the IBD patients who were diagnosed with anemia in this study received treatment. Of the patients with IDA, 23% received oral iron therapy and 40.3% received parenteral iron preparations. Of those with B12/folic acid anemia, 53.3% received B12/folic acid treatment. None of the patients in the current study received blood transfusions or were given erythropoiesis stimulant agents.

Research conclusions

Since almost half of IBD patients have anemia, and because anemia causes a multitude of negative effects on patients, its presence should be further examined, and if necessary, treated with regards to disease activity. It should be kept in mind that the most common cause of anemia is iron deficiency. Treatment rates should be increased in IBD patients with anemia.

Research perspectives

Anemia in IBD patients must be monitored throughout active and remissive disease and treated accordingly.