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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

doi: 10.1097/MIB.0b013e31829ed855
Original Clinical Articles

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.

Article first published online 30 July 2013Supplemental Digital Content is Available in the Text.

*Human Nutrition, School of Medicine, College of Medical, Veterinary and Life Sciences, Royal Hospital for Sick Children Glasgow, University of Glasgow, Glasgow, United Kingdom; and

Department of Paediatric Gastroenterology and Nutrition, Royal Hospital for Sick Children Glasgow, National Health Service Greater Glasgow and Clyde, Glasgow, United Kingdom.

Reprints: Konstantinos Gerasimidis, PhD, School of Medicine, College of Medicine, Veterinary and Life Sciences, Royal Hospital for Sick Children, University of Glasgow, Glasgow G3 8SJ, United Kingdom (e-mail:

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (

K.G. was funded by the Greek State Scholarship Foundation, the Hellenic Foundation of Gastroenterology & Nutrition, and the Barr Endowment Fund. The IBD team at Yorkhill Hospital, Glasgow, is supported by the Catherine McEwan Foundation and Yorkhill IBD fund. R.K.R. is supported by an NHS Research Scotland career fellowship award.

The authors have no conflicts of interest to disclose.

Received May 01, 2013

Accepted June 03, 2013

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