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P434. Iron deficiency anemia in inflammatory bowel disease: are we treating our patients efficiently?

D. Trabulo, C. Teixeira, J. Mangualde, I. Cremers, A.P. Oliveira, Centro Hospitalar de Setúbal - Hospital de São Bernardo, Gastroenterology, Setúbal, Portugal

Background

Iron deficiency anemia (IDA) is a common complication of inflammatory bowel disease (IBD) known to negatively impact quality of life. However, this condition appears to be under-diagnosed and undertreated. Guidelines for IDA diagnosis and treatment were recently updated, but their applicability in daily practice is still unknown. Our objectives were to survey the prevalence and characteristics of anemia in IBD patients, to correlate it with the type of disease and to evaluate the effectiveness of several iron compounds in its treatment.

Methods

Retrospective study of IBD patients followed-up in our outpatient clinic in a 3 year period. Demographic, clinical and laboratorial data were collected from patient files. Response to therapy with different iron compounds was based on variation of hemoglobin (Hb) - complete response if Hb variation ≥2 g/dL). Statistical analysis with Chi-square and Student's t tests (significance level = 0.05).

Results

From a clinic with 430 registered patients, we evaluated 149 patients: 49 years-old mean-age at study entry; 53% males; 40% had Crohn's disease (CD) and 60% had ulcerative colitis (UC). Mean duration of disease was 10.4 years. Anemia was found in 31% of the patients, of whom 96% showed associated IDA. Mean baseline Hb was 9.9 g/dL. Prevalence of anemia was higher in CD than in UC (40% vs 27%;p = 0.07). Patients with CD took more years to be diagnosed with anemia (p = 0.01). Presence of anemia was associated with female gender (p = 0.005), higher IBD activity, steroid use, need of hospitalization (p=0), and increased acute phase reactants (p = 0.001). 52% were treated with oral iron, 43% with iron sucrose (2x200 mg/week) and 37% with ferric carboxymaltose (1 g/infusion, 1-week intervals). 38% of patients reported intolerance to oral iron. No adverse reactions to intravenous iron were found. Complete response rate to intravenous iron was significantly higher than oral iron therapy (73% vs 17%, p = 0.045), but there were no significant differences between iron sucrose (70%) or ferric carboxymaltose (76%) - p = 0.06. Mean duration of oral iron therapy was 12 weeks; iron sucrose 4 weeks and ferric carboximaltose 2 weeks.

Conclusion

Anemia is common in IBD patients, with a greater prevalence in CD disease than in UC. The presence of IDA is associated with disease severity. However, in our study, the majority of IDA patients were treated with oral iron, presenting an inadequate response, greater side effects and superior treatment time. Complete response with ferric carboxymaltose was superior to iron sucrose and duration of the former treatment was lower. Awareness of gastroenterologists needs to be directed to the diagnosis and treatment of IDA in these patients. Intravenous iron compounds should be advocated.