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P440. Macrocytic anemia secondary to sulphasalazine in patients affected by ulcerative colitis and Crohn's colitis: a real issue?

E. Loll1, E. Calabrese1, P. Scarozza1, G. Condino1, M. Ascolani1, S. Onali1, C. Petruzziello1, F. Zorzi1, L. Biancone1, F. Pallone1, 1University of Rome Tor Vergata, GI Unit, Medicine, Rome, Italy

Background

Anaemia is a multifactorial complication of inflammatory bowel disease (IBD) with a wide prevalence of 9–74%. Sulphasalazine (SASP) inhibits methylene-tetrahydrofolate reductase, impairing folate absorption and subsequently affecting erythropoiesis. Megaloblastic anaemia during SASP therapy has been reported, but not quantified. Our retrospective study evaluated the presence of macrocytic anaemia related to folate deficiency in patients (pts) treated with SASP, affected by ulcerative colitis (UC) or Crohn's disease (CD) colitis.

Methods

A total of 236 UC and CD colitis pts were analyzed retrospectively. Fifty-six per cent of pts were excluded from the final analysis. One hundred four out of 236 pts (44%) were analysed. Eighty-nine UC pts (55 M; median age 51; median disease duration 144 mos; 61.8% extensive colitis, 13.5% left UC, 24.7% distal UC) and 15 CD pts (6 M; median age 36; median disease duration 84 mos; 46.7% penetrating behaviour, 53.3% non penetrating non structuring) were considered.

Results

In UC group 4/89 pts had concomitant diseases possibly interfering with folate absorption (celiac disease in 1 and microcythemia in 3). Eighty-four per cent of pts were in remission. The median follow-up was 54 mos. SASP duration therapy was 60 mos; concomitant treatments possibly interfering with folate absorption were proton pump inhibitors in 14.6% of pts, immunomodulators in 10% of pts, hypoglycemic agents in 4.5% of pts, and NSAIDs in 12.4% of pts. Thirty out of 89 pts (33.8%) had anaemia (17/30 with normal MCV, 10/30 with reduced MCV, 1/30 with increased MCV, 2/30 undefined). Only 6/30 pts (20%) were taking folate supplementation and 6/30 (20%) iron supplementation.

In colonic CD group 1/15 pts was affected by microcythemia. Thirteen out of 15 pts were in remission. The median follow-up of 34 mos. SASP duration therapy was 24 mos; concomitant treatments possibly interfering with folate absorption were proton pump inhibitors in 6.6% of pts, immunomodulators in 26.7% of pts. Five out of 15 pts (33.4%) had anaemia (3/5 with normal MCV, 1/5 with reduced MCV, 1/5 undefined). Only 1/5 pts (20%) was taking folate supplementation and 1/5 (20%) iron supplementation.

Folate levels were normal in both groups but only one pt had folate deficiency with no anaemia.

Conclusion

In our retrospective study considering UC and colonic CD pts treated with SASP, a low rate of macrocytic anemia was found and very few patients underwent folate supplementation.