S1036 Anemia in Inflammatory Bowel Disease: Differences Between Private Practice and University Hospital: A Prospective Study

Abstract

Background and Aim: Anemia is a common complication of inflammatory bowel disease (IBD) in both Crohn's disease (CD) and ulcerative colitis (UC). Studies on anemia in patients with IBD are usually conducted in tertiary referral centers. Unfortunately, data from private clinical practice is missing. The aim of the present study was to investigate the occurrence of anemia in IBD patients from University Hospitals and from private practices and to compare those results to healthy blood donor candidates. Methods: Data (such as age, gender, hemoglobine level, disease severity) was acquired prospectively from patients included in the Swiss IBD Cohort Study. The control population consisted of healthy first-time blood donor candidates at the blood transfusion center, Swiss Red Cross, Basel. IBD activity was measured in CD by the Crohn's disease activity index (CDAI) and in UC by the modified Truelove and Witts activity index (MTWAI). Anemia was defined as haemoglobin level ≤ 120 g/l in women and ≤ 130 g/l in men. Iron deficiency anemia was defined by a ferritin level 150, MTWAI >3) was defined as iron deficiency anemia in combination with anemia of chronic disease. Results: 125 patients from University Hospitals (66 CD and 59 UC) and 116 patients from private practices (71 CD and 45 UC) were included and compared to a control population (6074 blood donor candidates). In women from University Hospitals, anemia was significantly more frequent than in women from private practice and healthy female blood donors (30.4% vs. 11.9% vs 4.0%, p< 0.0001). In men anemia was less pronounced but reached statistical significance (27.8% vs. 14.3% vs. 2.8%, p< 0.001). CDAI was significantly higher in University Hospitals as compared to private practice (97.1± 72.4 vs. 64.7± 58.8, p=0.006) whereas the MTWAI was comparable (5.4 ± 4.5 vs. 3.9 ± 3.9, p=0.07). Anemia caused by iron deficiency was found in 60% of the IBD-patients from tertiary centers with anemia, but just in 18% of the IBD patients from private practice with anemia (p= 0.025). Supplementation therapy with iron/folic acid/vitamin B12 was applied more often in private practice than in University Hospitals (42% vs. 27%, p=0.01). Conclusions: Frequency of anemia in IBD patients is high in both tertiary referral centers and in private practice but is more pronounced in tertiary referral centers. The anemia is mainly caused by iron deficiency indicating that private practice gastroenterologists are more aware of potential iron deficiency and subsequent substitution therapy.