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P552. Current practice in the diagnosis and management of IBD-associated anemia and iron deficiency in Germany: The German AnemIBD study

I. Blumenstein1, S. Vollmer2, W. Klemm3, G. Virgin4, S. Weber-Mangal4, J. Stein5, 1Frankfurt University Hospital, Medical Dpt. 1, Frankfurt, Germany, 2Gastroenterological Practice, Göppingen, Germany, 3Gastroenterological Practice, Cottbus, Germany, 4Vifor Pharma Germany, Munich, Germany, 5Crohn Colitis Zentrum Rhein-Main, Frankfurt, Germany

Background

Anemia represents the most common systemic complication in inflammatory bowel disease (IBD). Although the cause of anemia in IBD is multifactorial, iron deficiency (ID) is one of the most prevalent underlying reasons. Recent IBD guidelines suggest that iron supplementation should be preferably administered intravenously, even though some patients may respond to orally administered iron (Gasche et al. IBD; 2007). The results of a non-interventional study (NIS) give insight into the current status of anemia management in German IBD patients.

Methods

Up to August 2010, 193 IBD patients (116 Crohn's disease [CD] and 78 colitis ulcerosa [CU]) were included in the NIS. Mean patient age was 39 years (range: 36–83 yrs.) with 79 (41%) male patients included. Enrolled subjects suffered from IBD and anemia and had received care at their study center for at least 12 months prior study inclusion.

Results

54 office-based gastroenterologists reported 193 cases of IBD-associated anemia. Anemia and iron status were mainly assessed by hemoglobin (Hb; 100%) and serum ferritin (97%). Transferrin saturation (TSAT) was tested in 82% of patients. Mean Hb at diagnosis was 10.1±1.4 g/dL, serum ferritin 51.2±122 µg/L and transferrin saturation (TSAT) 14.0±12.6%. In the 6 months prior to inclusion, only 84 (43.5%) of patients had received anti-anemic treatment. Of those 47 (56%) had received oral iron, 13 (15%) parenteral iron, 16 (19%) oral plus parenteral iron and 8 (10%) transfusions. Erythropoetin stimulating agents had not been given.

Conclusion

Although i.v. administration of iron is recommended as the preferred route for iron therapy for IBD patients, current practice in Germany continues to rely on oral iron preparations in most iron-treated patients with IBD, even when severely anemic. Insufficient replacement of iron or monitoring of iron status is indicated by the frequency of severe anemia in this cohort of 193 patients. The proportion of patients with IBD and inadequately or untreated anemia and/or iron deficiency remains to be determined, however greater awareness of the existing guidelines for managing iron deficiency in IBD patients appears necessary.