1 The Department of Hepatology and Gastroenterology V, Faculty of Health Sciences, Aarhus University, Aarhus University2 Crohn Colitis Center Rhein, Frankfurt an Main3 Department of Clinical Medicine - The Department of Hepatology and Gastroenterology V, Department of Clinical Medicine, Health, Aarhus University4 Karolinska University Hospital, Stockholm5 Istituto Clinico Humanitas, Milan6 Medical University, Vienna7 Hôspital Charles Nicolle, Rouen8 Hospital de Sao Joan, Porto9 Centro Médico Teknon, Barcelona10 Vifor Pharma, Glattburg11 University Medical Center, Utrecht12 John Radcliffe Hospital, Oxford13 Department of Clinical Medicine - The Department of Hepatology and Gastroenterology V, Department of Clinical Medicine, Health, Aarhus University
Aim: Iron deficiency (ID), a common complication of inflammatory bowel disease (IBD), can trigger hospitalization and increase morbidity. Intravenous (I.V.) iron is the recommended treatment for IBD-associated anemia. This study evaluated current European practice in diagnosis and treatment of IBD-associated anemia. Materials & Methods: Gastroenterologists from 4 European countries (Austria, Italy, The Netherlands and Sweden) completed questionnaires on the last five IBD patients treated for anemia within six months. The survey was performed between August and September 2010 and recorded details on patient demographics, blood tests, Hb-levels and iron parameters at diagnosis, and anemia therapies within twelve months prior to the survey. Results: 116 gastroenterologists (105 hospital-, 11 office-based) reported 575 cases of IBD-associated anemia. Anemia and iron status were mainly assessed by hemoglobin (Hb; 77%) and serum ferritin (58%). Transferrin saturation (TSAT) was tested in only 17% of patients. Median Hb at diagnosis was 9.4 g/dL (8.4-10.6 g/dL; Q1[25%]-Q3[75%]), ferritin 12.0 µg/L (7-30 µg/L) and TSAT 15.0% (8-34%). Severe anemia (Hb <10 g/dL) was present in 59%, including 18% with Hb <8 g/dL. Evaluation of the iron status recorded absolute iron deficiency (ferritin <30 µg/L) in 74% and insufficient availability of iron (indicated by a TSAT <20%) in 58% of tested patients. 95% of patients had received iron as treatment in the twelve months prior the survey. In Austria, Italy and the Netherlands 69-87% received oral iron for treating iron deficiency identified at the time of the survey, and only a minority (17-48%) received I.V. iron (few patients were switched between the iron administration routes during the twelve month period). In Sweden, 75% of iron-treated patients were treated with I.V. iron (p<0.001 vs. average of all countries). Blood transfusions or erythropoiesis-stimulating agents (ESAs) were given in 12% and 19% of patients, respectively. Notably, ESAs were either given at low rates (<10%) or to about a quarter of patients. Conclusions: Although I.V. administration of iron is recommended as the preferred route for iron therapy, current practice continues to rely on oral iron preparations in most iron-treated patients with IBD, even when severely anemic. Insufficient replacement of iron or monitoring of iron status is indicated by the frequency of severe anemia in this cohort of 575 patients. The proportion of patients with IBD and untreated anemia or iron deficiency remains to be established, but greater awareness of guidelines for managing iron deficiency in IBD appears appropriate.