The burden and management of anemia in Greek patients with inflammatory bowel disease: a retrospective, multicenter, observational study

BMC Gastroenterol. 2021 Jun 29;21(1):269.doi: 10.1186/s12876-021-01826-1.

Kalliopi Foteinogiannopoulou 1, Konstantinos Karmiris 2, Georgios Axiaris 3, Magdalini Velegraki 2, Antonios Gklavas 4, Christina Kapizioni 5, Charalabos Karageorgos 6, Christina Kateri 7, Anastasia Katsoula 8, Georgios Kokkotis 9, Evgenia Koureta 10, Charikleia Lamouri 11, Panagiotis Markopoulos 12, Maria Palatianou 13, Ploutarchos Pastras 14, Konstantinos Fasoulas 15, Olga Giouleme 8, Evanthia Zampeli 3, Aggeliki Theodoropoulou 2, Georgios Theocharis 14, Konstantinos Thomopoulos 14, Pantelis Karatzas 10, Konstantinos H Katsanos 11, Andreas Kapsoritakis 7, Anastasia Kourikou 6, Nikoleta Mathou 16, Spilios Manolakopoulos 6, Georgios Michalopoulos 5, Spyridon Michopoulos 3, Alexandros Boubonaris 17, Giorgos Bamias 9, Vasileios Papadopoulos 7, George Papatheodoridis 10, Ioannis Papaconstantinou 4, Ioannis Pachiadakis 17, Konstantinos Soufleris 15, Maria Tzouvala 13, Christos Triantos 14, Eftychia Tsironi 12, Dimitrios K Christodoulou 11, Ioannis E Koutroubakis 18, Hellenic group for the study of IBD


  • Hellenic group for the study of IBD: 

Kalliopi Foteinogiannopoulou, Konstantinos Karmiris, Georgios Axiaris, Magdalini Velegraki, Antonios Gklavas, Christina Kapizioni, Charalabos Karageorgos, Christina Kateri, Anastasia Katsoula, Georgios Kokkotis, Evgenia Koureta, Charikleia Lamouri, Panagiotis Markopoulos, Maria Palatianou, Ploutarchos Pastras, Konstantinos Fasoulas, Olga Giouleme, Evanthia Zampeli, Aggeliki Theodoropoulou, Georgios Theocharis, Konstantinos Thomopoulos, Pantelis Karatzas, Konstantinos H Katsanos, Andreas Kapsoritakis, Anastasia Kourikou, Nikoleta Mathou, Spilios Manolakopoulos, Georgios Michalopoulos, Spyridon Michopoulos, Alexandros Boubonaris, Giorgos Bamias, Vasileios Papadopoulos, George Papatheodoridis, Ioannis Papaconstantinou, Ioannis Pachiadakis, Konstantinos Soufleris, Maria Tzouvala, Christos Triantos, Eftychia Tsironi, Dimitrios K Christodoulou, Ioannis E Koutroubakis


Author information

  • 1Dept of Gastroenterology, University Hospital Heraklion, P.O. BOX 1352, 71110, Heraklion, Crete, Greece. drfpopi@hotmail.com.
  • 2Department of Gastroenterology, Venizelio General Hospital, Heraklion, Greece.
  • 3Department of Gastroenterology, General Hospital of Athens "Alexandra", Athens, Greece.
  • 42nd Department of Surgery, Aretaieion Hospital, National and Kapodistrian University of Athens, Athens, Greece.
  • 5Department of Gastroenterology, General Hospital of Piraeus "Tzaneio", Athens, Greece.
  • 6Hepato-Gastroenterology/Endoscopy Unit, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Athens General Hospital "Heppocratio", Athens, Greece.
  • 7Department of Gastroenterology, University General Hospital of Larissa, Larissa, Greece.
  • 82nd Internal Medicine Department, General Hospital of Thessaloniki "Ippokratio", Thessaloniki, Greece.
  • 9Gastroenterology Unit, 3rd Academic Department of Internal Medicine, National and Kapodistrian Univeristy of Athens, "Sotiria" General Hospital, Athens, Greece.
  • 10Department of Gastroenterology, National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens, Greece.
  • 11Department of Gastroenterology, University General Hospital of Ioannina, Ioannina, Greece.
  • 12Department of Gastroenterology, "Metaxa" General Anticancer Hospital of Piraeus, Piraeus, Greece.
  • 13Department of Gastroenterology, General Hospital of Nikaia Piraeus "Ag. Panteleimon"-General Hospital Dytikis Attikis "Agia Varvara", Athens, Greece.
  • 14Division of Gastroenterology, Department of Internal Medicine, University Hospital of Patras, Patras, Greece.
  • 15Department of Gastroenterology-Oncology, Theageneio Cancer Hospital of Thessaloniki, Thessaloniki, Greece.
  • 16Department of Gastroenterology, General Hospital of Nea Ionia "Konstantopoulio - Patision", Athens, Greece.
  • 17Department of Gastroenterology, 424 General Military Hospital, Thessaloniki, Greece.
  • 18Dept of Gastroenterology, University Hospital Heraklion, P.O. BOX 1352, 71110, Heraklion, Crete, Greece.


Background: Anemia is a common extraintestinal manifestation of Inflammatory Bowel Disease (IBD) affecting negatively the patients' quality of life. The aim of this study was to determine the frequency and real-life management of anemia in IBD patients in Greece.

Methods: This study was conducted in 17 Greek IBD referral centers. Demographic, clinical, laboratory, IBD and anemia treatment data were collected and analyzed retrospectively.

Results: A total of 1394 IBD patients [560 ulcerative colitis (UC), 834 Crohn's disease (CD)] were enrolled. Anemia at any time was reported in 687 (49.3%) patients of whom 413 (29.6%) had episodic and 274 (19.7%) had recurrent/persistent anemia. Anemia was diagnosed before IBD in 45 (6.5%), along with IBD in 269 (39.2%) and after IBD in 373 (54.3%) patients. In the multivariate analysis the presence of extraintestinal manifestations (p = 0.0008), IBD duration (p = 0.026), IBD related surgeries and hospitalizations (p = 0.026 and p = 0.004 accordingly) were risk factors of recurrent/persistent anemia. Serum ferritin was measured in 839 (60.2%) IBD patients. Among anemic patients, 535 (77.9%) received treatment. Iron supplementation was administered in 485 (90.6%) patients, oral in 142 (29.3%) and intravenous in 393 (81%).

Conclusions: The frequency of anemia in IBD patients, followed at Greek referral centers, is approximately 50%. Development of recurrent/persistent anemia may be observed in 20% of cases and is independently associated with the presence of extraintestinal manifestations, IBD duration, IBD related surgeries and hospitalizations. Anemia treatment is administered in up to [Formula: see text] of anemia IBD patients with the majority of them receiving iron intravenously.


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