Intest Res.  2016 Jan;14(1):43-49. 10.5217/ir.2016.14.1.43.

The prevalence and clinical characteristics of anemia in Korean patients with inflammatory bowel disease

• Lee DS
• Bang KB
• Kim JY
• Jung YS
• Park JH
• Kim HJ
• Cho YK
• Sohn CI
• Jeon WK
• Kim BI
• Choi KY
• Park DI

• KMID: 2174509
• DOI: http://doi.org/10.5217/ir.2016.14.1.43

Abstract

BACKGROUND/AIMS
Quality of life is closely related to anemia in patients with inflammatory bowel disease (IBD). Several studies have reported on anemia in patients with IBD in Western countries. This study investigated the prevalence and clinical characteristics of anemia in Korean patients with IBD.
METHODS
We reviewed the medical records of 92 patients with ulcerative colitis (UC) and 76 patients with Crohn's disease (CD) who were followed regularly at a single tertiary medical center in Korea between January 2003 and December 2012. Hemoglobin (Hb) thresholds used to define anemia were <13.0 g/dL in men and <12.0 g/dL in women according to the World Health Organization criteria. We chose the lowest Hb level in each year as a representative value because Hb levels changed at each examination and anemia was associated with disease deterioration. The relationship between clinical variables and lowest Hb level was assessed.
RESULTS
The prevalence of anemia was 36.3% in patients with UC and 41.6% in patients with CD. Anemia in patients with CD was associated with hospital admission, 5-aminosalicylate (5-ASA) and infliximab treatment in men. Anemia in patients with UC was associated with hospital admission, oral steroid use, thiopurine and infliximab treatment in men.
CONCLUSIONS
The prevalence of anemia in Korean patients with IBD was comparable to that of patients in Western countries. Anemia was associated with male patients with CD who were admitted to the hospital and received medications including 5-ASA and infliximab, and men with UC who were admitted to the hospital and received medications including oral steroids, thiopurine and infliximab.

Keyword

Crohn disease; Colitis, ulcerative; Anemia

MeSH Terms

Anemia*
Colitis, Ulcerative
Crohn Disease
Female
Humans
Infliximab
Inflammatory Bowel Diseases*
Korea
Male
Medical Records
Mesalamine
Prevalence*
Quality of Life
Steroids
World Health Organization
Mesalamine
Steroids

Figure

• 

  Fig. 1 Prevalence of anemia in patients with IBD. Mean prevalence of anemia in patients with IBD is higher than that of the general population. Anemia is more common in patients with CD than those with UC. There was a larger variation in the prevalence of anemia in patients with CD than those with UC. (A) The prevalence of anemia is higher in women with UC than in men with UC (41.4% in women and 33.1% in men). (B) The prevalence of anemia is higher in women with CD than in men with CD (56.6% in women and 39.4% in men).

• 

  Fig. 2 Hemoglobin (Hb) level in IBD patients. The mean Hb level is higher in patients with UC than in patients with CD. (A) Male patients with UC are not anemic during the follow up period, while female patients with UC are not anemic during the second half of a 10-years follow up period. (B) CD patients are anemic during most time of follow period. This anemia is more severe in females with CD than in males with CD.

Reference

1. Høivik ML, Reinisch W, Cvancarova M, Moum B. IBSEN study group. Anaemia in inflammatory bowel disease: a populationbased 10-year follow-up. Aliment Pharmacol Ther. 2014; 39:69–76. PMID: 24172277.

2. Pizzi LT, Weston CM, Goldfarb NI, et al. Impact of chronic conditions on quality of life in patients with inflammatory bowel disease. Inflamm Bowel Dis. 2006; 12:47–52. PMID: 16374258.

3. Kim YJ. Intravenous iron and oral iron treatment in anemia of inflammatory bowel disease. Intest Res. 2013; 11:227–228.

4. Wells CW, Lewis S, Barton JR, Corbett S. Effects of changes in hemoglobin level on quality of life and cognitive function in inflammatory bowel disease patients. Inflamm Bowel Dis. 2006; 12:123–130. PMID: 16432377.

5. Evans RW, Rader B, Manninen DL. The quality of life of hemodialysis recipients treated with recombinant human erythropoietin. Cooperative Multicenter EPO Clinical Trial Group. JAMA. 1990; 263:825–830. PMID: 2404150.

6. Gasché C, Dejaco C, Waldhoer T, et al. Intravenous iron and erythropoietin for anemia associated with Crohn disease. A randomized, controlled trial. Ann Intern Med. 1997; 126:782–787. PMID: 9148651.

7. Auerbach M. Oral or IV iron in inflammatory bowel disease. Am J Gastroenterol. 2012; 107:950. author reply 950-951. PMID: 22664849.

8. Gomollón F, Gisbert JP. Current management of iron deficiency anemia in inflammatory bowel diseases: a practical guide. Drugs. 2013; 73:1761–1770. PMID: 24114623.

9. Cronin CC, Shanahan F. Anemia in patients with chronic inflammatory bowel disease. Am J Gastroenterol. 2001; 96:2296–2298. PMID: 11513165.

10. Wilson A, Reyes E, Ofman J. Prevalence and outcomes of anemia in inflammatory bowel disease: a systematic review of the literature. Am J Med. 2004; 116(Suppl 7A):44S–49S. PMID: 15050885.

11. Lennard-Jones JE. Classification of inflammatory bowel disease. Scand J Gastroenterol Suppl. 1989; 170:2–6. discussion 16-19PMID: 2617184.

12. Dignass A, Lindsay JO, Sturm A, et al. Second European evidence-based consensus on the diagnosis and management of ulcerative colitis part 2: current management. J Crohns Colitis. 2012; 6:991–1030. PMID: 23040451.

13. Dignass A, Van Assche G, Lindsay JO, et al. The second European evidence-based Consensus on the diagnosis and management of Crohn's disease: Current management. J Crohns Colitis. 2010; 4:28–62. PMID: 21122489.

14. Satsangi J, Silverberg MS, Vermeire S, Colombel JF. The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications. Gut. 2006; 55:749–753. PMID: 16698746.

15. Silverberg MS, Satsangi J, Ahmad T, et al. Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. Can J Gastroenterol. 2005; 19(Suppl A):5A–36A.

16. Koller O. The clinical significance of hemodilution during pregnancy. Obstet Gynecol Surv. 1982; 37:649–652. PMID: 7145246.

17. McLean E, Cogswell M, Egli I, Wojdyla D, de Benoist B. Worldwide prevalence of anaemia, WHO Vitamin and Mineral Nutrition Information System, 1993-2005. Public Health Nutr. 2009; 12:444–454. PMID: 18498676.

18. Harries AD, Fitzsimons E, Dew MJ, Heatley RV, Rhodes J. Association between iron deficiency anaemia and mid-arm circumference in Crohn's disease. Hum Nutr Clin Nutr. 1984; 38:47–53. PMID: 6693295.

19. Schreiber S, Howaldt S, Schnoor M, et al. Recombinant erythropoietin for the treatment of anemia in inflammatory bowel disease. N Engl J Med. 1996; 334:619–623. PMID: 8592524.

20. Solberg IC, Lygren I, Jahnsen J, et al. Clinical course during the first 10 years of ulcerative colitis: results from a populationbased inception cohort (IBSEN Study). Scand J Gastroenterol. 2009; 44:431–440. PMID: 19101844.

21. Solberg IC, Vatn MH, Høie O, et al. Clinical course in Crohn's disease: results of a Norwegian population-based ten-year follow-up study. Clin Gastroenterol Hepatol. 2007; 5:1430–1438. PMID: 18054751.

22. Spivak JL. Iron and the anemia of chronic disease: vindication for the non-essential role of iron supplementation. Oncology (Williston Park). 2011; 25:421–423. PMID: 21710838.

23. Gearry RB, Barclay ML. Azathioprine and 6-mercaptopurine pharmacogenetics and metabolite monitoring in inflammatory bowel disease. J Gastroenterol Hepatol. 2005; 20:1149–1157. PMID: 16048561.

24. Avni T, Bieber A, Steinmetz T, Leibovici L, Gafter-Gvili A. Treatment of anemia in inflammatory bowel disease-systematic review and meta-analysis. PLoS One. 2013; 8:e75540. PMID: 24312441.

25. Lugg S, Beal F, Nightingale P, Bhala N, Iqbal T. Iron treatment and inflammatory bowel disease: what happens in real practice? J Crohns Colitis. 2014; 8:876–880. PMID: 24486177.