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. 2015 Oct;13(10):1760-6.
doi: 10.1016/j.cgh.2015.03.029. Epub 2015 Apr 8.

Persistent or Recurrent Anemia Is Associated With Severe and Disabling Inflammatory Bowel Disease

Ioannis E Koutroubakis  1 , Claudia Ramos-Rivers  1 , Miguel Regueiro  1 , Efstratios Koutroumpakis  1 , Benjamin Click  1 , Robert E Schoen  1 , Jana G Hashash  1 , Marc Schwartz  1 , Jason Swoger  1 , Leonard Baidoo  1 , Arthur Barrie  1 , Michael A Dunn  1 , David G Binion  2
Affiliations

Persistent or Recurrent Anemia Is Associated With Severe and Disabling Inflammatory Bowel Disease

Ioannis E Koutroubakis et al. Clin Gastroenterol Hepatol. 2015 Oct.

Abstract

Background & aims: Anemia is a common manifestation of inflammatory bowel disease (IBD) that can greatly affect patients' quality of life. We performed a prospective study of a large cohort of patients with IBD to determine if patterns of anemia over time are associated with aggressive or disabling disease.

Methods: We performed a longitudinal analysis of demographic, clinical, laboratory, and treatment data from a registry of patients with IBD at the University of Pittsburgh Medical Center from 2009 through 2013. Patients with a complete follow-up evaluation (at least 1 annual visit with laboratory results) were included. Anemia was defined by World Health Organization criteria. Disease activity scores (the Harvey-Bradshaw Index or the ulcerative colitis activity index) and quality-of-life scores (based on the short IBD questionnaire) were determined at each visit; laboratory data, including levels of C-reactive protein and erythrocyte sedimentation rates, as well as patterns of IBD-related health care use, were analyzed.

Results: A total of 410 IBD patients (245 with Crohn's disease, 165 with ulcerative colitis; 50.5% female) were included. The prevalence of anemia in patients with IBD was 37.1% in 2009 and 33.2% in 2013. Patients with IBD and anemia required significantly more health care and had higher indices of disease activity, as well as a lower average quality of life, than patients without anemia (P < .0001). Anemia (persistent or recurrent) for 3 or more years was correlated independently with hospitalizations (P < .01), visits to gastroenterology clinics (P < .001), telephone calls (P < .004), surgeries for IBD (P = .01), higher levels of C-reactive protein (in patients with ulcerative colitis, P = .001), and a higher erythrocyte sedimentation rate (P < .0001). Anemia was correlated negatively with quality-of-life scores (P < .03).

Conclusions: Based on a longitudinal analysis of 410 patients, persistent or recurrent anemia correlates with more aggressive or disabling disease in patients with IBD.

Keywords: C-Reactive Protein; Crohn's Disease; Erythrocyte Sedimentation Rate; Quality of Life; Ulcerative Colitis.

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Figures

Figure 1
Figure 1
Prevalence of anemia in inflammatory bowel disease patients over the 5 year period CD, Crohn’s disease; IBD, inflammatory bowel disease; UC, ulcerative colitis
Figure 2
Figure 2
The burden of anemia as expressed by years with anemia of the inflammatory bowel disease patients included in the study
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