Anemia and iron deficiency in Crohn's disease

Hospital Surgical Volume-Outcome Relationship of Postoperative Morbidity for Ileocolic Resection in Crohn's Disease: A French Nationwide Study of 4205 Patients

BACKGROUND AND AIMS

Despite the development of medical therapy, nearly 50% of patients with Crohn's disease [CD] undergo surgery during their lifetime. Several studies have suggested some risk factors for postoperative morbidity [POM] after ileocolic resection [ICR]. However, the impact of surgical hospital volume on POM in CD has not been extensively studied. This study aimed to assess the impact of surgical hospital volume on POM after ICR for CD.

METHODS

All patients with CD who underwent ICR in France between 2013 and 2022 were identified in the French Database, Programme de Médicalisation des Systèmes d'Information. Using the Chi-square automatic interaction detector, we determined the cut-off value to split high-surgical-volume [≥6 ICRs/year] and low-surgical-volume centres [<6 ICRs/year]. The primary outcome was the evaluation of major POM during hospitalization. POM was evaluated according to the surgical volume centre. The Elixhauser comorbidity index [ECI] was used to categorize the comorbidities of patients.

RESULTS

A total of 4205 patients were identified, and the major POM during hospitalization was significantly [p = 0.0004] lower in the high-surgical-volume [6.2%] compared to low-surgical-volume centres [9.1%]. After multivariate analysis, independent factors associated with major POM were surgical hospital volume [p = 0.024], male sex [p = 0.029], ECI ≥ 1 [p < 0.001], and minor POM [p < 0.001].

CONCLUSION

Major POM after ICR for CD is closely associated with surgical hospital volume. Centralization of surgery for CD is desirable, especially in patients with major comorbidities.

Dietary Profile of Patients with Inflammatory Bowel Disease in Clinical Remission-A Preliminary Study

Imbalanced dietary intake is associated with the development of inflammatory bowel diseases (IBDs) and is often observed during the active phases of Crohn's disease (CD) and ulcerative colitis (UC). Cumulative data also suggest the potential for dietary manipulation in avoiding IBD relapse. However, there is a paucity of dietary data from patients in clinical remission to guide such an approach. Our study aimed to characterize the dietary pattern and adequacy of patients with IBD in clinical remission. Data on dietary intake (three alternate 24 h food records) were collected from 40 patients with IBD (20 CD and 20 UC) and 45 gender-matched healthy controls (HC). Statistical comparisons between patients and controls employed Student's t-test, Mann-Whitney U, chi-squared, and Fisher's exact tests. The adequacy of dietary intake of IBD patients was further studied by assessing the nutrient inadequacy prevalence, estimated using the Dietary Reference Intakes (DRI) framework and the Estimated Average Requirement (EAR) parameter. We observed significant dietary imbalances among patients with IBD compared to the HC group, marked by disparities in both macronutrient and micronutrient intakes. Inadequacies with frequencies >80% were observed for the ingestion of total fiber and 13 micronutrients in IBD patients. Our preliminary findings suggest that imbalanced dietary intake is also characteristic among individuals with IBD during clinical remission, corroborating the need for dietary interventions in this population.

Long-Term Outcomes of Iron Deficiency Before and After Bariatric Surgery: a Systematic Review and Meta-analysis

PURPOSE

This study reviews the prevalence of iron deficiency (ID) in bariatric surgery candidates and the long-term outcomes of the prevalence of ID after bariatric surgery.

MATERIALS AND METHODS

A systematic literature search and meta-analysis were performed in PubMed for articles published by August 31, 2022, including these search terms: bariatric surgery, metabolic surgery, weight loss surgery, obesity surgery, sleeve gastrectomy, gastric banding, gastric bypass, duodenal switch, duodenojejunal bypass, iron, iron deficiency, sideropenia, and hypoferritinemia. Fifty-seven studies examining a total of 26,328 patients with morbidly obese were included in this meta-analysis finally.

RESULTS

The results showed a prevalence of 17% of ID in bariatric surgery candidates and a prevalence of 14%, 17%, 26%, 34%, 23%, 38%, and 23% of ID at 1-, 2-, 3-, 4-, 5-, 8-, and 10-year follow-up after bariatric surgery, respectively. Additionally, the results showed a prevalence of 15%, 19%, 35%, 38%, 29%, 30%, and 23% of ID at 1-, 2-, 3-, 4-, 5-, 8-, and 10-year follow-up after Roux-en-Y gastric bypass, respectively; a prevalence of 12%, 12%, 15%, 31%, and 17% of ID at 1-, 2-, 3-, 4-, and 5-year follow-up after sleeve gastrectomy, respectively; and a prevalence of 19% of ID at 1-year follow-up after anastomosis gastric bypass.

CONCLUSION

As a result, preoperative evaluation and correction of ID may lead to better outcomes for bariatric surgery candidates. ID is also common in patients after bariatric procedures, especially RYGB. Long-term, even lifelong, medical and nutritional monitoring and tailored interventions are critical.

A Retrospective Study Using Mentzer Index for Prevalence of Iron Deficiency Anemia among Infants Visiting Maternal Centers at the Age of One Year

Anemia, defined as a hemoglobin level two standard deviations below the mean for age, is prevalent in infants and children worldwide. Characterizing anemia as microcytic and normocytic depends on the mean corpuscular volume (MCV), which is an important parameter in differentiating many types of anemia. Microcytic anemia due to iron deficiency is the most common type of anemia in children. In this study, we aimed to assess the Mentzer index used by the Ministry of Health (MOH) in Palestine as a useful tool in differentiating between iron deficiency anemia (IDA) and thalassemia. We assessed for the prevalence of IDA among infants at the age of one year visiting the mother centers from seven West Bank provinces in Palestine. Medical records and hematology laboratory data of 3262 infants were retrospectively analyzed from the years of 2018 to 2020. The Mentzer index applied to all population by dividing mean corpuscular volume (MCV, in fL) by the red blood cell count (RBC, in millions per microliter). A corrected Mentzer index was further calculated among anemic infants to include only microcytic (MCV with less than 72 fl) and hypochromic (mean corpuscular hemoglobin concentration (MCHC) with less than 32 g/L) indices. Mentzer index calculations for the whole population showed that 29.1% were anemic (hemoglobin (HGB) less than 11 g/dl): 21.1% had mild anemia, 7.6% had moderate anemia, while 0.2% had severe anemia. The corrected Mentzer index calculations showed a prevalence of 5.9% and 3.2% among IDA and thalassemia infants, respectively. Severity of anemia was correlated with low body weight and infants born through cesarean mother birth with no interference with gender influence. CBC indices of RBC count, HGB, MCV, and mean corpuscular hemoglobin (MCH) showed a significant difference (p values < 0.05) between IDA and thalassemia infants' populations following the corrected Mentzer index. With the corrected Mentzer index, we introduced a new CBC index among infants at the age of 1 year in Palestine. These lab references could aid in differentiating IDA and thalassemia among the population and improve initial diagnosis screenings. The Mentzer index calculation for the whole population did not necessarily include cases of IDA, and therefore, it is recommended to comprise microcytic and hypochromic anemia indices prior to performing the Mentzer index.

The first tryptophan based turn-off chemosensor for Fe2+ ion detection

In this research work, we have designed and synthesized a novel Tryptophan-Quinoline conjugated turn-off chemosensor 4 for the selective detection of Fe²⁺ ion with high sensitivity (3.06 μM) among 21 metal cations such as Ag⁺, Ca⁺, Cs⁺, Cu⁺, K⁺, Na⁺, NH₄⁺, Ba²⁺, Ca²⁺, Cd²⁺, Co²⁺, Cu²⁺, Mn²⁺, Ni²⁺, Pb²⁺, Zn²⁺, Al³⁺, Au³⁺, Cr³⁺ and Fe³⁺ in DMF-HEPES (1 mM, pH = 7.0, 1:1, v/v) aqueous-organic solvent system. It showed a fluorescence quenching mechanism through the blocked PET process. The optical properties, binding mode of the metal ion with the receptor, plausible electron transfer mechanism, and its practical applications have been discussed. This work will open up a new avenue in amino acid-based Fe²⁺ ion sensors.

Inflammatory Bowel Diseases: Is There a Role for Nutritional Suggestions?

Nutrition has an important impact on inflammatory bowel diseases (IBD). In particular, several studies have addressed its role in their pathogenesis, showing how the incidence of IBD significantly increased in recent years. Meanwhile, nutrition should be considered a component of the treatment of the disease, both as a therapy itself, and especially in the perspective of correcting the various nutritional deficiencies shown by these patients. In this perspective, nutritional suggestions are very important even in the most severe forms of IBD, requiring hospitalization or surgical treatment. Although current knowledge about nutrition in IBD is increasing over time, nutritional suggestions are often underestimated by clinicians. This narrative review is an update summary of current knowledge on nutritional suggestions in IBD, in order to address the impact of nutrition on pathogenesis, micro- and macro-nutrients deficiencies (especially in the case of sarcopenia and obesity), as well as in hospitalized patients.

Hirschsprung's disease presenting as intractable anemia: a report of two cases and review of the literature

BACKGROUND

This report summarizes the clinical characteristics of intractable anemia as part of the clinical presentation of Hirschsprung's disease (HD) and aims to strengthen clinicians' ability to recognize early signs of HD.

CASE PRESENTATION

An 11-year-old boy with a 6-year history of intractable anemia, low hemoglobin level (55 g/L), poor response to oral iron supplementation and blood transfusion, and difficulty with defecation was diagnosed with HD. A 19-month-old boy with a 3-month history of intractable anemia, low hemoglobin level (64 g/L), poor response to oral iron supplementation and blood transfusion, delayed meconium passage, and history of intestinal obstruction was also diagnosed with HD. Both patients underwent surgery, after which anemia was corrected effectively in both cases. Two more cases of intractable anemia as the chief complaint and diagnoses of HD over different durations since the onset of anemia (ranging from 1.7 years to 21 years) were identified in a literature search. Both patients underwent surgery, after which anemia was corrected.

CONCLUSIONS

Intractable anemia as part of the clinical presentation of HD is extremely rare. Detailed inquiries of medical histories and physical examinations are key to early diagnoses and preventing misdiagnoses. Anemia in HD patients may primarily be caused by impaired iron absorption due to HD.