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P186 Prevalence and management of anaemia in Greek patients with inflammatory bowel disease: a multicentre real-life cohort study

K. Karmiris MD- PhD1, K. Fotinogiannopoulou2, M. Velegraki1, E. Koureta3, G. Axiaris4, C. Kateri5, G. Kokkotis6, C. Kapizioni7, P. Markopoulos8, A. Katsoula9, A. Gklavas10, I. Papaconstantinou10, O. Giouleme9, E. Tsironi8, G. Michalopoulos7, G. Bamias6, V. Papadopoulos5, A. Kapsoritakis5, E. Zampeli4, S. Michopoulos4, P. Karatzas3, G. Papatheodoridis3, A. Theodoropoulou1, I.E. Koutroubakis2

1Department of Gastroenterology, Venizeleio General Hospital, Heraklion, Greece, 2Department of Gastroenterology, University Hospital Heraklion, Heraklion, Greece, 3Department of Gastroenterology, Medical School of National and Kapodistrian University -–General Hospital ‘Laiko’, Athens, Greece, 4Department of Gastroenterology, Alexandra General Hospital, Athens, Greece, 5Department of Gastroenterology, University Hospital Larissa, Larissa, Greece, 6Department of Gastroenterology, Sotiria Hospital, Athens, Greece, 7Department of Gastroenterology, Tzaneio General Hospital, Piraeus, Greece, 8Department of Gastroenterology, Metaxa General Hospital, Piraeus, Greece, 9Department of Gastroenterology, Hippokration General Hospital,Thessaloniki, Greece, 10Department of Surgery, Aretaieion University Hospital, Athens, Greece

Background

Anaemia is a common extra intestinal manifestation of inflammatory bowel disease (IBD) that plays an important role in patients’ quality of life. The aim of our study was to evaluate the prevalence of anaemia and its current management in referral IBD centres in Greece.

Methods

We performed a retrospective analysis of demographic, clinical, laboratory and IBD-related treatment data as well as data concerning the type of anaemia and its treatment in IBD patients registered in 10 Greek tertiary referral centres. Consecutive patients (the last seen) having at least two follow-up visits with available to retrieve relevant laboratory results were included. Anaemia was defined by the World Health Organization criteria. Patients with co-morbidities related to anaemia were excluded.

Results

A total of 751 IBD patients have been registered so far and their demographic and clinical characteristics are presented in Table 1. The point prevalence of anaemia at inclusion was 26.8 % (201 patients), whereas the overall prevalence of history of anaemia was 38.7% (291 patients). The prevalence of anaemia was numerically higher in CD (41.1 %, n = 186) than in ulcerative colitis (35.2 %, n = 105) but the difference was not statistically significant (p = 0.13). Persistent anaemia (anaemia in all measurements) was found in 40 (13.7%) and recurrent anemia in 102 (35.1%) patients, whereas 54 (18.5 %) had a history of anaemia before IBD diagnosis. IBD patients with anaemia at entry had higher activity (HBI, SCCAI and CRP) and lower quality of life (SIBDQ) scores than patients without anaemia (for all comparisons p < 0.05). Among the 291 patients with anaemia iron supplementation was administered in 239 (82.3%); oral iron in 52 (17.9%) and iv iron in 205 (70.4%). Vitamin B12 and folate were administered in 54 and 107 patients, respectively.

Table 1. Demographic and clinical features of IBD patients (N = 751)

Male/female (%)397/354 (52.9/47.1)
CD/UC (%)453/298 (60.3/39.7)
Median age at IBD diagnosis (years, IQR)33 (23–45)
Median disease duration at entry (years, IQR)5 (2–11)
Active smokers (%)248 (33.0)
History of IBD-related surgery (%)88 (11.7)
Anemia at entry (%)201 (26.8)
History of anaemia (%)291 (38.7)
Anemia in CD/UC (%)186/105 (41.1/35.2)
Immunosupressants at entry (%)177 (23.6)
Biologics at entry (%)378 (50.3)
Iron supplementation (%)239 (82.3)
Oral/iv iron (%)52/205 (17.9/70.4)

Conclusion

The point prevalence of anaemia in Greek IBD patients is 26.8%. Almost half of the patients with anaemia present recurrent or persistent anaemia. The presence of anaemia is associated with active disease and lower quality of life. The vast majority of patients received iron supplementation mainly in the form of iv iron.