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P691 Frequency of anaemia and anaemia subtypes in east-west European inception cohort: an ECCO-EpiCom cohort study

J. Burisch*1, U. Gerdes2,3, S. Almer4, S. Čuković-Čavka5, S. Sebastian6, I. Kaimakliotis7, D. Duricova8, N. Pedersen9, R. Salupere10, K. R. Nielsen11,12, P. Manninen13, K. H. Katsanos14, S. Odes15, V. Andersen16,17, R. D’Inca18, L. Kupcinskas19, S. Turcan20, F. Magro21, 22, 23, A. Goldis24, K. Kofod Vinding25, E. Belousova26, K. Ladefoged27, Y. Bailey28, V. Hernandez29, J. Halfvarson30, N. Arebi31, O. Shonova32, M. L. Hoivik33, B. Moum34, E. Langholz35, P. L. Lakatos36, P. Munkholm1, J. F. Dahlerup37

1North Zealand University Hospital, Department of Gastroenterology, Frederikssund, Denmark, 2Region of Southern Denmark, Centre for Quality, Middelfart, Denmark, 3University of Southern Denmark, Institute of Regional Health Research, Odense, Denmark, 4County council of Östergötland, Department of Gastroenterology/UHL, Linköping, Sweden, 5University Hospital Centre Zagreb, University of Zagreb School of Medicine, Division of Gastroenterology and Hepatology, Zagreb, Croatia, 6Hull Royal Infirmary, Hull and East Yorkshire NHS Trust & Hull and York Medical School, Hull, United Kingdom, 7Nicosia Private practice, Nicosia Private practice, Nicosia, Cyprus, 8Charles University, IBD Centre ISCARE, Prague, Czech Republic, 9Slagelse Hospital, Department of Gastroenterology, Slagelse, Denmark, 10Tartu University Hospital, Division of Endocrinology and Gastroenterology, Tartu, Estonia, 11The National Hospital of the Faroe Islands, Medical department, Tórshavn, Faroe Islands, 12Genetic Biobank, Tórshavn, Faroe Islands, 13Tampere University Hospital, Department of Gastroenterology and Alimentary Tract Surgery, Tampere, Finland, 14University Hospital, Ioannina, 1st Division of Internal Medicine and Hepato-Gastroenterology Unit, Ioannina, Greece, 15Soroka Medical Centre and Ben-Gurion University of the Negev, Department of Gastroenterology and Hepatology, Beer Sheva, Israel, 16Viborg Regional Hospital, Medical Department, Viborg, Denmark, 17Hospital of Southern Jutland, Medical Department, Aabenraa, Denmark, 18On behalf of the EpiCom Northern Italy, Florence, Forlì, and Padova, Northern Italy, Italy, 19Lithuanian University of Health Sciences, Institute for Digestive Research, Kaunas, Lithuania, 20State University of Medicine and Pharmacy of the Republic of Moldova, Department of Gastroenterology, Chisinau, Moldova, Republic of, 21University of Porto, Institute for molecular and cell biology, Porto, Portugal, 22Hospital de São João, Department of Gastroenterology, Porto, Portugal, 23Oporto Medical School, Institute of Pharmacology and Therapeutics, Porto, Portugal, 24University of Medicine ‘Victor Babes’, Clinic of Gastroenterology, Timisoara, Romania, 25Amager Hospital, Department of medicine, Amager, Denmark, 26Moscow Regional Research Clinical Institute, Department of Gastroenterology, Moscow, Russian Federation, 27Dronning Ingrids Hospital, Medical Department, Nuuk, Greenland, 28Adelaide and Meath Hospital, TCD, Department of Gastroenterology, Dublin, Ireland, 29Complexo Hospitalario Universitario de Vigo, Gastroenterology Department, Vigo, Spain, 30Faculty of Medicine and Health, Örebro University, Department of Gastronterology, Örebro, Sweden, 31St Mark’s Hospital, Gastroenterology, London, United Kingdom, 32Nemocnice Ceske Budejovice, Department of Gastroenterology, Ceske Budejovice, Czech Republic, 33Oslo University Hospital, Department of Gastroenterology, Oslo, Norway, 34Oslo University Hospital, Department of Gastroenterology, Oslo, Norway, 35Gentofte Hospital, Department of Medical Gastroenterology, Copenhagen, Denmark, 36Semmelweis University, 1st Department of Medicine, Budapest, Hungary, 37Aarhus University Hospital, Department of Hepatology and Gastroenterology, Aarhus, Denmark

Background

The EpiCom-cohort is a European prospective population-based cohort of unselected, uniformly diagnosed patients with inflammatory bowel disease (IBD) in 2010 from 31 Western and Eastern European centres.1 Previous data have shown that significantly more patients in Western Europe receive biological therapy, but surgery and hospitalisation rates did not differ between regions.2 The aim of the current study was to investigate the occurrence of anaemia, as well as differences between Eastern and Western Europe, during the first year of disease.

Methods

Patients were followed prospectively from the time of diagnosis. Clinical data on surgery, medical treatment, hospitalisation, and blood samples were captured throughout the follow-up period. Anaemia and its subtypes were defined according to the World Health Organisation and ECCO guideline.

Results

In total, 827 patients aged 15 years or older from 29 centres (20 Western; 9 Eastern European) were eligible for analysis, of whom 433 (52%) had ulcerative colitis (UC), 300 (37%) had Crohn’s disease (CD), and 94 (11%) had IBD unclassified (IBDU). The proportion of patients with anaemia and its subtypes at diagnosis and at follow-up is shown in Table 1. Overall, anaemia was more frequent in Eastern than in Western European patients for both CD and UC. After 1 year of follow-up, the proportion of patients with anaemia decreased but significantly more patients in Eastern Europe remained anaemic, Figure 1.

Figure 1. Change in anaemia frequency during follow-up.

Table 1. Prevalence of anaemia at diagnosis and at 1-year follow-up

Ulcerative colitisCrohn’s disease
Eastern 
Europe
diagnosisEastern 
Europe
follow-upWestern 
Europe
diagnosisEastern 
Europe
follow-upEastern 
Europe
diagnosisEastern 
Europe
follow-upWestern 
Europe
diagnosisEastern 
Europe
follow-up
Anaemia overall43%26%29%13%58%25%45%45%
Iron deficiency6%3%3%2%7%4%1%0%
Anaemia of chronic disease9%3%3%1%13%0%12%1%
Mixed anaemia6%1%1%1%24%7%17%1%
Other anaemia6%4%4%2%2%0%6%2%
CU unclassified14%16%16%6%13%15%10%9%

Conclusion

In this unselected, population-based inception cohort the frequency of anaemia was high at the time of diagnosis, especially for CD, but decreased during the first year of follow-up. More Eastern than Western European patients remained anaemic after 1 year of follow-up. These geographic differences could be caused by differences in awareness of anaemia or they might reflect differences in global care and inflammation control of IBD patients in Europe.

References

[1] Burisch J, Pedersen N, Čuković-Čavka S, et al. East-West gradient in the incidence of inflammatory bowel disease in Europe: the ECCO-EpiCom inception cohort. Gut 2014;63(4):588–97.

[2] Burisch J, Pedersen N, Čuković-Čavka S, et al. Initial disease course and treatment in an inflammatory bowel disease inception cohort in Europe: the ECCO-EpiCom cohort. Inflamm Bowel Dis 2014;20(1):36–46.