Anemia in Crohn's Disease-The Unseen Face of Inflammatory Bowel Disease.

Iolanda Valentina Popa,Cătălina Mihai,Lucian Vasile Boiculese,Mihaela Dranga,Mariana Floria,Oana Irina Gavril,Anca Trifan,Otilia Gavrilescu,Oana-Bogdana Bărboi,Cristina Cijevschi Prelipcean

doi:10.3390/medicina57101046

Abstract

Background and Objectives: Anemia is the most frequent complication of inflammatory bowel diseases. Clinically, anemia can affect important quality-of-life (QoL) components, such as exercise capacity, cognitive function, and the ability to carry out social activities. The disease activity has a significant impact on QoL, mainly due to clinical manifestations, which are more severe during the periods of disease activity. Our aim was to estimate the impact of anemia on QoL in patients with Crohn’s disease. Material and Methods. We made a prospective study on 134 patients with Crohn’s disease (CD) in a Romanian tertiary center. The CD diagnosis was established by colonoscopy and histopathological examination. In particular cases, additional examinations were required (small bowel capsule endoscopy, computed tomography enterography, and magnetic resonance enterography). Anemia was defined according to the World Health Organization’s definition, the activity of the disease was assessed by Crohn’s disease activity index (CDAI) score, and the QoL was evaluated by Inflammatory Bowel Disease Questionnaire 32 (IBDQ 32). Results: 44.8% patient had anemia, statistically related to the activity of the disease and corticoids use. We found a strong association between QoL and disease activity on all four sub-scores: patients with more severe activity had a significantly lower IBDQ (260.38 ± 116.96 vs. 163.85 ± 87.20, p = 0.001) and the presence of anemia (127.03 vs. 148.38, p = 0.001). In multiple regression analyses, both disease activity and anemia had an impact on the QoL. Conclusions: Anemia has high prevalence in the CD in northeastern region of Romania. Anemia was more common in female patients, in patients undergoing corticosteroid treatment, and in those with active disease. Both anemia and disease activity had a strong negative and independent impact on QoL.

Highlights

Anemia is the most frequent complication of inflammatory bowel diseases (IBDs), with a prevalence that varies between 6% and 74% [1]
The study included 134 patients with Crohn’s disease (CD)—both patients with a history of CD and patients who were at their first diagnosis—who were evaluated during this period in a Romanian tertiary center
From a practical point of view, our study has demonstrated that both the treatment of flare and the treatment of anemia are needed to increase the QoL of CD patients (Figure 1)

Summary

Introduction

Anemia is the most frequent complication of inflammatory bowel diseases (IBDs), with a prevalence that varies between 6% and 74% [1]. The most frequent cause is determined by the iron deficit (chronic loss, poor absorption due to mucosa inflammation and ulceration, and short bowel syndrome); there may be other etiological factors, 4.0/). Such as vitamin B12 and folic acid deficiency, the effects of proinflammatory cytokines, or hemolysis and certain drugs [2]. Anemia was more common in female patients, in patients undergoing corticosteroid treatment, and in those with active disease Both anemia and disease activity had a strong negative and independent impact on QoL

Objectives

Methods

Discussion

Conclusion