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P165 The distribution and severity of small bowel inflammatory activity forecast the emergence of anemia and nutricional deficits in Crohn's Disease

P. Boal Carvalho*1, F. Dias de Castro1, B. Rosa1, M.J. Moreira1, J. Cotter1, 2, 3

1Centro Hospitalar do Alto Ave, Gastroenterology, Guimaraes, Portugal, 2Universidade do Minho, Life and Health Sciences Research Institute, Braga/Guimarães, Portugal, 3ICVS/3B’s , PT Associate Laboratory, Braga/Guimarães, Portugal

Background

Crohn's Disease (CD) affects the small bowel in over 80% of the patients, and may result, among others, in anemia and nutritional deficiencies, in consequence of malabsorption and inflammatory bowel activity.

We aimed to analyze and correlate the presence of anemia and nutritional deficiencies (iron, folic acid, Vitamin B12, albumin and total proteins) with both the extent and severity in small bowel inflammatory activity, using small bowel capsule endoscopy (SBCE), through the Lewis Score (LS).

Methods

Retrospective single-center study, including patients with exclusively small bowel CD undergoing SBCE between January/2007 and June/2014. Exclusion criteria: patients with small bowel resection surgery as well as patients with red blood cell transfusions or nutritional supplements (iron, folic acid, Vitamin B12) in the 3 months prior to SBCE.

We assessed hemoglobin, iron, iron binding capacity, ferritin, folic acid, Vitamin B12, albumin and total protein serum levels at the moment of the SBCE procedure. Small bowel inflammatory activity was assessed, according to LS, in each tertile (< 135 - no inflammatory activity; 135-790 - mild inflammatory activity; ≥ 790 - moderated to severe inflammatory activity).

Results

Included 69 patients, 62% (n=43) were female, with mean age 33 years (range 18-75); inflammatory activity was observed in 41 (59%) patients, and was moderate to severe in 28 (41%).

Eighteen patients (26%) presented with anemia, and 74% (n=51) with iron deficit (defined as ferritin levels < 100 ng/mL or transferrin saturation < 16%); nutritional deficits of albumin, folic acid and Vitamin B12 were encountered in 4 patients each (8,7%). Proximal small bowel disease was significantly correlated with lower acid folic serum levels (p=0,004). LS superior to 790, independently of disease location, was significantly associated with anemia (p=0,039) and low serum proteins (p=0,002).

Conclusion

In our series, we observed an important prevalence of both anemia and iron deficit. Proximal inflammatory activity in the small bowel was significantly associated with lower folic acid levels, while anemia and low serum proteins were correlated with the severity of the inflammatory lesions, assessed through Lewis Score, regardless of their distribution.