Inflammatory Bowel Diseases

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Inflammatory Bowel Diseases:
doi: 10.1097/MIB.0b013e31829ed855
Original Clinical Articles

The Epidemiology of Anemia in Pediatric Inflammatory Bowel Disease: Prevalence and Associated Factors at Diagnosis and Follow-up and the Impact of Exclusive Enteral Nutrition

Gerasimidis, Konstantinos PhD*; Barclay, Andrew MD; Papangelou, Alexandros MSc*; Missiou, Despoina MSc*; Buchanan, Elaine BSc; Tracey, Cardigan BSc; Tayler, Rachel MB, ChB; Russell, Richard K. PhD; Edwards, Christine A. PhD*; McGrogan, Paraic MB, ChB

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Background: Anemia is poorly studied in pediatric inflammatory bowel disease. This study explored the epidemiology and associated factors of anemia at diagnosis, after 1 year, and during treatment with exclusive enteral nutrition (EEN).

Methods: Three cohorts were included: (1) a representative population of newly diagnosed inflammatory bowel disease children (n = 184); (2) patients currently receiving care with data available at diagnosis (n = 179) and after 1 year (n = 139); and (3) 84 children treated with EEN.

Results: At diagnosis, 72% were anemic. Abnormal inflammatory markers were more common in Crohn’s disease with severe anemia (severe versus no anemia [%]: raised C-reactive protein; 89% versus 48%; suboptimal albumin; 97% versus 29%; P < 0.002). Anemic children with Crohn’s disease had shorter diagnosis delay and lower BMI than nonanemic patients (severe versus mild versus no anemia, median [interquartile range]; diagnosis delay [months]: 3 [3.9] versus 6 [10] versus 8 [18], P < 0.001; BMI z score [SD]: −1.4 [1.4] versus −1.3 [1.5] versus −0.2 [1.4], P = 0.003). Extensive colitis was associated with severe anemia in ulcerative colitis. The proportion of severely anemic patients decreased from 34% to 9% and mild anemia doubled at 1 year. After EEN, severe anemia decreased (32% to 9%; P < 0.001) and the hemoglobin concentration increased by 0.75 g/dL. This was observed only after 8 weeks of treatment. Disease improvement and low hemoglobin at EEN initiation but not weight gain were associated with hemoglobin improvement.

Conclusions: Anemia is high at diagnosis and follow-up and should receive more attention from the clinical team; however, the focus should remain suppression of inflammatory process in active disease.

© Crohn's & Colitis Foundation of America, Inc.

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