P279 Prevalence of iron deficiency in inflammatory bowel disease
Resál, T.(1);Bacsur, P.(1);Lupas, D.(2);Szántó, K.(1);Rutka, M.(1);Fábián, A.(1);Bor, R.(1);Szepes, Z.(1);Farkas, K.(1);Varga, M.(2);Molnár, T.(1);
(1)University of Szeged, Department of Medicine- Szent-Györgyi Albert Medical School- University of Szeged, Szeged, Hungary;(2)Békés County Central Hospital, Department of Internal Medicine, Békéscsaba, Hungary;
Background
Iron deficiency (ID) is one of the most common extraintestinal manifestation of inflammatory bowel disease, which often remains untreated, despite the fact, that ID significantly impairs patients' quality of life. Since anaemia develops through several pathomechanisms (e.g., occult bleeding, chronic inflammation, medicines), treating anaemia requires to manage the underlying pathological changes as well.
Methods
In our prospective, two-centers study, we assessed the frequency of ID among our IBD patients. The diagnosis of iron deficiency (iron deficiency anaemia [IDA], anaemia of chronic inflammation [CDA], anaemia of mixed origin [AMO]) was based on the ECCO’s anaemia guideline. According to the guideline, haemoglobin, CRP, ferritin, transferrin saturation, serum iron values, total iron binding capacity, hematocrit, and platelet counts were collected from our patients on a one-off basis. We aimed to compare the frequency of ID in a biologic centre, and in a non-biologic centre hospital as well. In addition, we assessed the frequency of the need for oral and intravenous iron replacement, respectively, based on the guideline as well.
Results
720 patients were included in our study (CD 58.8%, UC 41.2 %). Average age was 43.3 years. We found, that 26.6% of our patients had anemia. There was no significant difference in the prevalence of ID (p=0.65) between CD and UC patients. Based on the ECCO criteria, 61.8% of them have ID (33.0% IDA, 23.0% AMO, 5.8% CDA), and in the rest of the cases (38.2%) it was classified to be anaemia of other origin (AOO), however, in 68.5% of these cases ID can be suspected at some degree, as ferritin was < 100 mg/l and/or transferrin saturation ≤ 20%. In total, 133 patients (69.6%) had anaemia in remission, and 58 patients (30.4%) in case of activity (CRP ≥10 mg/l). In addition, we found an association between elevated CRP levels and the prevalence/severity of anemia (p<0.001) as mean CRP was 5.9 mg/l in the non-anaemic, 9.9 mg/l in the anaemic, and 16.0 mg/l in the severe anaemic group. Anemia (p<0.001) and iron deficiency anemia (p<0.001) were significantly more common in patients treated in a clinical/biological centre, compared to a non-biological hospital. Patients with active disease received iv. ferric-carboximaltose, which turned to be efficient (Hgb>120-130 g/l) already after 2 months in 76.5% of the cases.
Conclusion
Based on our results, anemia and iron deficiency are common complications of IBD and correlate well with disease activity. Consequently, we suggest, that iron deficiency should be a part of the treat to target approach, and in case of ID, iv. ferric-carboximaltose is efficient in activity as well.