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Woźniak M, Borkowska A, Jastrzębska M, Sochal M, Małecka-Wojciesko E, Talar-Wojnarowska R. Clinical and Laboratory Characteristics of Anaemia in Hospitalized Patients with Inflammatory Bowel Disease. J Clin Med 2023; 12:jcm12072447. [PMID: 37048531 PMCID: PMC10095056 DOI: 10.3390/jcm12072447] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/02/2023] [Accepted: 03/06/2023] [Indexed: 04/14/2023] Open
Abstract
Anaemia is the most common extraintestinal manifestation of inflammatory bowel disease (IBD). Due to its multifactorial etiopathogenesis, the differential diagnosis and treatment of anaemia in IBD is a significant clinical problem. The main aim of our study was to assess the usefulness of laboratory parameters, including hepcidin, in differential diagnoses of anaemia in hospitalized IBD patients. This study also estimated the impact of anaemia on the length of hospitalization and its relationship with clinical data of analyzed patients. The study included 118 adult patients diagnosed with IBD-55 with ulcerative colitis (UC) and 63 with Crohn's disease (CD). Anaemia was significantly more frequent in patients with CD-42 (66.7%)-compared to 31 (56.4%) patients with UC (p = 0.033). The prevalence of anaemia increased significantly with the severity of IBD and the extent of inflammatory changes in the endoscopic examination. Hospitalization time was significantly longer in patients with anaemia, especially in the group with UC. Ferritin concentrations < 30 ng/mL were found only in 15 (20.55%) IBD patients (9 with UC and 6 with CD), and ferritin < 100 ng/mL was observed in 22 (30.14%) patients, equally frequent with UC and CD (p > 0.05). Significantly higher concentrations of transferrin were observed in patients with anaemia in the course of UC compared to CD (2.58 ± 0.90 g/L vs. 2.15 ± 0.82 g/L; p = 0.037). On the other hand, saturation of transferrin < 16% was equally common in UC and CD patients. In our study, hepcidin levels in anaemic UC patients were significantly lower compared to UC without anaemia (p = 0.042), with no similar differences in CD independently of anaemia presence (p = 0.565). To conclude, we observed a high incidence of anaemia in patients with IBD and its significant impact on the length of hospitalization in UC. Routinely determined single laboratory parameters are not sufficient for the differential diagnosis of anaemia, and a complex laboratory assessment, including of hepcidin levels, is necessary for the full picture of anaemia in the course of IBD.
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Affiliation(s)
- Małgorzata Woźniak
- Department of Digestive Tract Diseases, Medical University of Lodz, 90-419 Lodz, Poland
| | - Anna Borkowska
- Department of Internal Diseases and Diabetology, Medical University of Lodz, 90-419 Lodz, Poland
| | - Marta Jastrzębska
- Department of Gastroenterology, Health Care Center, 26-200 Konskie, Poland
| | - Marcin Sochal
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, 90-419 Lodz, Poland
| | - Ewa Małecka-Wojciesko
- Department of Digestive Tract Diseases, Medical University of Lodz, 90-419 Lodz, Poland
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Loveikyte R, Boer M, van der Meulen CN, ter Steege RWF, Tack G, Kuyvenhoven J, Jharap B, Vu MK, Vogelaar L, West RL, van der Marel S, Römkens TEH, Mujagic Z, Hoentjen F, van Bodegraven AA, van Schaik FDM, de Vries AC, Dijkstra G, van der Meulen-de Jong AE. Anemia and Iron Deficiency in Outpatients with Inflammatory Bowel Disease: Ubiquitous Yet Suboptimally Managed. J Clin Med 2022; 11:jcm11226843. [PMID: 36431320 PMCID: PMC9692778 DOI: 10.3390/jcm11226843] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/11/2022] [Accepted: 11/17/2022] [Indexed: 11/22/2022] Open
Abstract
Background: Iron deficiency (ID) and anemia in patients with Inflammatory Bowel Disease (IBD) are associated with a reduced quality of life. We assessed the prevalence of ID and anemia in Dutch outpatients with IBD and compared routine ID(A) management among medical professionals to the European Crohn’s and Colitis Organisation (ECCO) treatment guidelines. Methods: Between January and November 2021, consecutive adult outpatients with IBD were included in this study across 16 Dutch hospitals. Clinical and biochemical data were extracted from medical records. Additionally, medical professionals filled out questionnaires regarding routine ID(A) management. Results: In total, 2197 patients (1271 Crohn’s Disease, 849 Ulcerative Colitis, and 77 IBD-unclassified) were included. Iron parameters were available in 59.3% of cases. The overall prevalence of anemia, ID, and IDA was: 18.0%, 43.4%, and 12.2%, respectively. The prevalence of all three conditions did not differ between IBD subtypes. ID(A) was observed more frequently in patients with biochemically active IBD than in quiescent IBD (ID: 70.8% versus 23.9%; p < 0.001). Contrary to the guidelines, most respondents prescribed standard doses of intravenous or oral iron regardless of biochemical parameters or inflammation. Lastly, 25% of respondents reported not treating non-anemic ID. Conclusions: One in five patients with IBD suffers from anemia that—despite inconsistently measured iron parameters—is primarily caused by ID. Most medical professionals treat IDA with oral iron or standard doses of intravenous iron regardless of biochemical inflammation; however, non-anemic ID is often overlooked. Raising awareness about the management of ID(A) is needed to optimize and personalize routine care.
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Affiliation(s)
- Roberta Loveikyte
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden University, 2333 ZA Leiden, The Netherlands
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
| | - Menno Boer
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden University, 2333 ZA Leiden, The Netherlands
| | - Catharina N. van der Meulen
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden University, 2333 ZA Leiden, The Netherlands
| | - Rinze W. F. ter Steege
- Department of Gastroenterology and Hepatology, Martini Hospital, 9728 NT Groningen, The Netherlands
| | - Greetje Tack
- Department of Gastroenterology and Hepatology, Medical Center Leeuwarden, 8934 AD Leeuwarden, The Netherlands
| | - Johan Kuyvenhoven
- Department of Gastroenterology and Hepatology, Spaarne Gasthuis Hospital, 2000 AK Haarlem, The Netherlands
| | - Bindia Jharap
- Department of Gastroenterology and Hepatology, Meander Medical Center, 3813 TZ Amersfoort, The Netherlands
| | - My K. Vu
- Department of Gastroenterology and Hepatology, Alrijne Hospital, 2350 CC Leiderdorp, The Netherlands
| | - Lauran Vogelaar
- Department of Gastroenterology and Hepatology, Diakonessenhuis Hospital, 3582 KE Utrecht, The Netherlands
| | - Rachel L. West
- Department of Gastroenterology and Hepatology, Franciscus Gasthuis & Vlietland Hospital, 3004 BA Rotterdam, The Netherlands
| | - Sander van der Marel
- Department of Gastroenterology and Hepatology, Haaglanden Medical Center, 2512 VA The Hague, The Netherlands
| | - Tessa E. H. Römkens
- Department of Gastroenterology and Hepatology, Jeroen Bosch Hospital, 5223 GZ Den Bosch, The Netherlands
| | - Zlatan Mujagic
- Department of Gastroenterology and Hepatology, Maastricht University Medical Center+, Maastricht University, 6229 HX Maastricht, The Netherlands
| | - Frank Hoentjen
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Radboud University, 6525 GA Nijmegen, The Netherlands
- Division of Gastroenterology, University of Alberta, Edmonton, AB T6G 2X8, Canada
| | - Adriaan A. van Bodegraven
- Department of Gastroenterology, Geriatrics, Internal- and Intensive Care Medicine (COMIK), Zuyderland Medical Center, 6130 MB Sittard-Geleen, The Netherlands
| | - Fiona D. M. van Schaik
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht University, 3584 CX Utrecht, The Netherlands
| | - Annemarie C. de Vries
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Erasmus University Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Gerard Dijkstra
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
| | - Andrea E. van der Meulen-de Jong
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden University, 2333 ZA Leiden, The Netherlands
- Correspondence: ; Tel.: +31-71-5263507
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Lu N, Yu M, Feng L. Bone Marrow Mesenchymal Stem Cells (BMSC) Carried with miR-338 Improve BMSC Homing in Intestinal Mucosa of Inflammatory Bowel Disease (IBD) Rats Through Increasing C-X-C Chemokine Receptor Type 4 (CXCR-4). J BIOMATER TISS ENG 2022. [DOI: 10.1166/jbt.2022.3067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This study assessed whether bone marrow mesenchymal stem cells (BMSC) carried with miR-338 improve its homing in intestinal mucosa of IBD rats. Fifty SD rats were equally and randomly assigned into control set, model set, miR-338 set, CXCR-4 Inhibitor set and positive control set followed
by analysis of miR-338 expression, body weight, DAI grade, pathological changes of distal colonic tissue, ultra-microstructure of intestinal epithelium, level of IL-8, IL-10, TGF-β1, VEGF, and CXCR4, as well as the relation between miR-338 and CXCR-4. miR-338 in decorated BMSC
was significantly upregulated. Body weight in model set and CXCR-4 Inhibitor set was lowest followed by miR-338 set and positive control set. However, opposite results were obtained for DAI grade. IL-8 level was highest and IL-10 was lowest in model set and CXCR-4 Inhibitor set. The BMSC carried
with miR-338 exerted recovery action on the intestinal mucosa of IBD rats and inhibited the activity of inflammatory cells. In conclusion, BMSC carried with miR-338 develops recovery action on the intestinal mucosa of IBD rats possibly through regulation of CXCR4, indicating that miR-338 might
be a target for the treatment of IBD.
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Affiliation(s)
- Na Lu
- Department of Anorectal, Southern District of Guang’anmen Hosptital, China Academy of Chinese Medical Science, Beijing, 102618, China
| | - Miao Yu
- Department of Surgical Oncology, Beijing Traditional Chinese Medicine Hospital Affiliated to Capital Medical University, Beijing, 100010, China
| | - Lipeng Feng
- Department of Anorectal, Guang’anmen Hospital, China Academy of Chinese Medical Science, Beijing, 100053, China
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Mahadea D, Adamczewska E, Ratajczak AE, Rychter AM, Zawada A, Eder P, Dobrowolska A, Krela-Kaźmierczak I. Iron Deficiency Anemia in Inflammatory Bowel Diseases-A Narrative Review. Nutrients 2021; 13:nu13114008. [PMID: 34836263 PMCID: PMC8624004 DOI: 10.3390/nu13114008] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 11/04/2021] [Accepted: 11/05/2021] [Indexed: 12/13/2022] Open
Abstract
Inflammatory bowel disease (IBD), which includes Crohn's disease and ulcerative colitis, is characterized by chronic inflammation of the gastrointestinal tract. IBD has been associated with numerous symptoms and complications, with the most common being iron deficiency anemia (IDA). Iron deficiency in IBD is caused by inadequate intake, malabsorption (including duodenal involvement and surgical removal), and chronic blood loss by mucosal ulcerations. Therefore, an appropriate diet should be enforced. Iron deficiency and iron supplementation have been associated with alterations to gut microbiota. IBD-associated anemia, in particular iron deficiency anemia, is associated with a significant decrease in quality of life and with clinical symptoms such as chronic fatigue, headaches and dizziness, reduced exercise tolerance, pale skin, nails, conjunctiva, and fainting. However, despite these numerous adverse symptoms, IDA remains undertreated. The European Crohn's and Colitis Organisation (ECCO) guidelines state that patients should be monitored for anemia. Adequate treatment, whether oral or intravenous, should be implemented while taking into consideration C-reactive protein values (CRP), hemoglobin levels, and therapeutic response. It should be stressed that every case of anemia in IBD patients should be treated. Intravenous iron formulations, which are more superior compared to the oral form, should be used. There is a need to increase awareness and implementation of international guidelines on iron supplementation in patients with IBD.
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Foteinogiannopoulou K, Karmiris K, Axiaris G, Velegraki M, Gklavas A, Kapizioni C, Karageorgos C, Kateri C, Katsoula A, Kokkotis G, Koureta E, Lamouri C, Markopoulos P, Palatianou M, Pastras P, Fasoulas K, Giouleme O, Zampeli E, Theodoropoulou A, Theocharis G, Thomopoulos K, Karatzas P, Katsanos KH, Kapsoritakis A, Kourikou A, Mathou N, Manolakopoulos S, Michalopoulos G, Michopoulos S, Boubonaris A, Bamias G, Papadopoulos V, Papatheodoridis G, Papaconstantinou I, Pachiadakis I, Soufleris K, Tzouvala M, Triantos C, Tsironi E, Christodoulou DK, Koutroubakis IE. Correction to: The burden and management of anemia in Greek patients with inflammatory bowel disease: a retrospective, multicenter, observational study. BMC Gastroenterol 2021; 21:301. [PMID: 34325662 PMCID: PMC8323283 DOI: 10.1186/s12876-021-01872-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Kalliopi Foteinogiannopoulou
- Gastroenterology Department, University Hospital of Heraklion, Medical School University of Crete, P.O. BOX 1352, 71110, Heraklion, Crete, Greece.
| | | | - Georgios Axiaris
- Department of Gastroenterology, General Hospital of Athens "Alexandra", Athens, Greece
| | - Magdalini Velegraki
- Department of Gastroenterology, Venizelio General Hospital, Heraklion, Greece
| | - Antonios Gklavas
- 2nd Department of Surgery, Aretaieion Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Christina Kapizioni
- Department of Gastroenterology, General Hospital of Piraeus "Tzaneio", Athens, Greece
| | - Charalabos Karageorgos
- Hepato-Gastroenterology/Endoscopy Unit, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Athens General Hospital "Heppocratio", Athens, Greece
| | - Christina Kateri
- Department of Gastroenterology, University General Hospital of Larissa, Larissa, Greece
| | - Anastasia Katsoula
- 2nd Internal Medicine Department, General Hospital of Thessaloniki "Ippokratio", Thessaloniki, Greece
| | - Georgios Kokkotis
- Gastroenterology Unit, 3rd Academic Department of Internal Medicine, National and Kapodistrian Univeristy of Athens, "Sotiria" General Hospital, Athens, Greece
| | - Evgenia Koureta
- Department of Gastroenterology, National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens, Greece
| | - Charikleia Lamouri
- Department of Gastroenterology, University General Hospital of Ioannina, Ioannina, Greece
| | - Panagiotis Markopoulos
- Department of Gastroenterology, "Metaxa" General Anticancer Hospital of Piraeus, Piraeus, Greece
| | - Maria Palatianou
- Department of Gastroenterology, General Hospital of Nikaia Piraeus "Ag. Panteleimon"-General Hospital Dytikis Attikis "Agia Varvara", Athens, Greece
| | - Ploutarchos Pastras
- Division of Gastroenterology, Department of Internal Medicine, University Hospital of Patras, Patras, Greece
| | - Konstantinos Fasoulas
- Department of Gastroenterology-Oncology, Theageneio Cancer Hospital of Thessaloniki, Thessaloniki, Greece
| | - Olga Giouleme
- 2nd Internal Medicine Department, General Hospital of Thessaloniki "Ippokratio", Thessaloniki, Greece
| | - Evanthia Zampeli
- Department of Gastroenterology, General Hospital of Athens "Alexandra", Athens, Greece
| | | | - Georgios Theocharis
- Division of Gastroenterology, Department of Internal Medicine, University Hospital of Patras, Patras, Greece
| | - Konstantinos Thomopoulos
- Division of Gastroenterology, Department of Internal Medicine, University Hospital of Patras, Patras, Greece
| | - Pantelis Karatzas
- Department of Gastroenterology, National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens, Greece
| | | | - Andreas Kapsoritakis
- Department of Gastroenterology, University General Hospital of Larissa, Larissa, Greece
| | - Anastasia Kourikou
- Hepato-Gastroenterology/Endoscopy Unit, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Athens General Hospital "Heppocratio", Athens, Greece
| | - Nikoleta Mathou
- Department of Gastroenterology, General Hospital of Nea Ionia "Konstantopoulio - Patision", Athens, Greece
| | - Spilios Manolakopoulos
- Hepato-Gastroenterology/Endoscopy Unit, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Athens General Hospital "Heppocratio", Athens, Greece
| | | | - Spyridon Michopoulos
- Department of Gastroenterology, General Hospital of Athens "Alexandra", Athens, Greece
| | | | - Giorgos Bamias
- Gastroenterology Unit, 3rd Academic Department of Internal Medicine, National and Kapodistrian Univeristy of Athens, "Sotiria" General Hospital, Athens, Greece
| | | | - George Papatheodoridis
- Department of Gastroenterology, National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens, Greece
| | - Ioannis Papaconstantinou
- 2nd Department of Surgery, Aretaieion Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Pachiadakis
- Department of Gastroenterology, 424 General Military Hospital, Thessaloniki, Greece
| | - Konstantinos Soufleris
- Department of Gastroenterology-Oncology, Theageneio Cancer Hospital of Thessaloniki, Thessaloniki, Greece
| | - Maria Tzouvala
- Department of Gastroenterology, General Hospital of Nikaia Piraeus "Ag. Panteleimon"-General Hospital Dytikis Attikis "Agia Varvara", Athens, Greece
| | - Christos Triantos
- Division of Gastroenterology, Department of Internal Medicine, University Hospital of Patras, Patras, Greece
| | - Eftychia Tsironi
- Department of Gastroenterology, "Metaxa" General Anticancer Hospital of Piraeus, Piraeus, Greece
| | | | - Ioannis E Koutroubakis
- Gastroenterology Department, University Hospital of Heraklion, Medical School University of Crete, P.O. BOX 1352, 71110, Heraklion, Crete, Greece
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