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P286. Prevalence of anaemia in children with inflammatory bowel disease

A. Thangarajah1, J.R. Goodhand2, V. Forsyth1, M. Marlais1, J. Epstein1, J.E.M. Fell1, D.J. Rawat1, J. Köglmeier1

1Department of Paediatric Gastroenterology, Chelsea and Westminster foundation NHS trust, London, United Kingdom; 2Digestive Diseases Clinical Academic Unit, Barts and the London School of Medicine and Dentistry., London, United Kingdom

Background: Anaemia is the most frequent complication of Inflammatory bowel disease (IBD) affecting about 20% of adult patients at any one time; half of whom are iron deficient (IDA) [1,2]. Few studies have reported the prevalence of anaemia in children with gastrointestinal (GI) complaints and or IBD, where dietary restrictions may conceivably worsen iron deficiency.

Aims and Objectives: We aimed to compare the prevalence of anaemia in IBD with a group of GI disease controls, and identify disease characteristics that predict anaemia.

Methods: We conducted a retrospective case–control study. Using electronic case note review we identified 46 consecutive paediatric IBD patients attending our tertiary Paediatric Gastroenterology Unit, (20 ulcerative colitis (UC), 2 indeterminate colitis and 24 Crohn's (CD)). 40 children with GI complaints with no underlying organic pathology were used as controls. Anaemia was defined using WHO criteria [1], patients with co-existing haemoglobinopathies were excluded. Disease activity was defined by global clinician's assessment and/or CRP > 5 mg/l. Disease extent and behaviour were recorded according to the Montreal classification. Differences between the IBD group and controls were sought using Fisher's exact test and Mann Whitney-U test.

Results: There was no significant difference between the median ages (range) of the IBD group compared with controls 13 (5–16), 12 (5–16) yrs respectively. Prevalence of anaemia in the IBD group was 71.7% (33/46) and significantly greater than in the controls 17.5% (7/40) (p < 0.001), too few patients had haematinics or iron studies to determine type of anaemia. Mean haemoglobin in the anaemic UC and CD group was 10.2 (8.0–11.9) compared to 10.6 (8.2–12.4) g/dl respectively. Overall only 6% (2/33) of the anaemic group were treated with oral iron. Using univariate analysis, neither gender, disease type, extent, duration or activity; were found to be predictive of anaemia in IBD.

Conclusion: Anaemia is much more common in children with IBD. Despite this few children have their anaemia adequately assessed and fewer receive specific treatment. Further studies are needed to assess the prevalence of ID anaemia and anaemia of chronic disease and the impact of iron supplementation and erythropoetin on symptoms of anaemia, quality of life and disease activity.

1. Gashe C et al. Guidelines on the diagnosis and management of iron deficiency and anaemia in Inflammatory bowel disease. Inflamm Bowel Dis, 2007:Dec1545–1553.

2. Gisbert J et al. A guide to diagnosis of iron deficiency anaemia and iron deficiency in digestive diseases. World J Gastroenterol 2009 Oct 7;15(37):4638–4643.