Background: Iron deficiency anemia (IDA) is an often unrecognized and undertreated complication of ulcerative colitis (UC). We conducted the first nationwide study in the United States to evaluate the prevalence of testing for iron deficiency (ID) in anemic UC patients and determine the frequency of treatment with iron supplementation in patients with IDA.
Methods: Nationwide cohort of patients with newly diagnosed UC in the Veterans Affairs health care system was identified. Primary outcome was to evaluate if anemic UC patients were tested for ID and subsequently treated with iron replacement therapy if IDA is confirmed. Candidate parameters included factors that can impact testing and treatment of anemia including patients' demographics, severity of anemia, and endoscopic findings.
Results: Of 836 newly diagnosed patients with UC, 585 patients (70%) developed anemia over the course of median 8 years of follow-up. Of 585 patients, 401 patients (68.6%) had iron study evaluation. Two hundred fifty-one patients (62.6%) were diagnosed with IDA, and among them, 191 patients (76.1%) were treated with oral iron therapy. None of the patient received intravenous iron therapy. In multivariate analysis, patients with mild/moderate anemia and patients from Midwest and South region were independent predictors of iron study evaluation in patients with anemia.
Conclusions: More than a third of anemic UC patients were not tested for ID. Once tested, almost a quarter of the patients with IDA were not treated with iron replacement therapy. Testing for ID and subsequent treatment with iron replacement therapy should be considered among the quality process indicators in UC.
Article first published online 18 October 2016.
*Section of Gastroenterology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;
†Section of Gastroenterology, VA Medical Center, Philadelphia, Pennsylvania; and
‡Department of Internal Medicine, Mercy Catholic Medical Center, Darby, Pennsylvania.
Address correspondence to: Nabeel Khan, MD, Section of Gastroenterology, Perelman School of Medicine, Philadelphia VA Medical Center, University of Pennsylvania, 3900 Woodland Avenue, Philadelphia, PA 19104 (e-mail: email@example.com).
Supported by an unrestricted grant from the Luitpold Pharmaceuticals. Luitpold pharmaceuticals currently manufactures ferric carboxymaltose and iron sucrose, while formerly manufactured iron dextran.
N. Khan received an unrestricted research grant from Luitpold pharmaceuticals. The study was conducted and the manuscript was written and reviewed solely by the authors. The remaining authors have no conflict of interest to disclose.
The study sponsor had no role in study design and analysis and interpretation of the data and in the writing of the report. The content of this report does not represent the views of the Department of Veterans Affairs or of Luitpold Pharmaceuticals.
Received August 30, 2016
Accepted September 1, 2016