Inflamm Bowel Dis. 2022 Apr 2;izac054. doi: 10.1093/ibd/izac054. Online ahead of print.

Gaetano Bergamaschi ¹, Fabiana Castiglione ², Renata D'Incà ³, Marco Astegiano ⁴, Walter Fries ⁵, Monica Milla ⁶, Carolina Ciacci ⁷, Fernando Rizzello ⁸, Simone Saibeni ⁹, Rachele Ciccocioppo ¹⁰, Ambrogio Orlando ¹¹, Fabrizio Bossa ¹², Mariabeatrice Principi ¹³, Piero Vernia ¹⁴, Chiara Ricci ¹⁵, Maria L Scribano ¹⁶, Giorgia Bodini ¹⁷, Dario Mazzucco ¹⁸, Gabrio Bassotti ¹⁹, Gabriele Riegler ²⁰, Andrea Buda ²¹, Matteo Neri ²², Flavio Caprioli ²³, Fabio Monica ²⁴, Aldo Manca ²⁵, Erica Villa ²⁶, Gionata Fiorino ^27 28, Michele Comberlato ²⁹, Nicola Aronico ¹, Cristina Della Corte ⁹, Roberta Caccaro ³, Paolo Gionchetti ⁸, Paolo Giuffrida ¹, Paola Iovino ⁷, Marco V Lenti ¹, Caterina Mengoli ¹, Lucienne Pellegrini ², Alberto Pieraccini ⁶, Davide Ribaldone ⁴, Anna Testa ², Cristina Ubezio ¹, Anna Viola ⁵, Maurizio Vecchi ²³, Catherine Klersy ³⁰, Antonio Di Sabatino ¹

Author information

¹Medicina Generale I, Fondazione stituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo e Università di Pavia, Pavia, Italy.

²Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy.

³Inflammatory Bowel Disease Unit-Azienda Ospedaliera-University of Padua, Padua, Italy.

⁴Gastroenterology and Digestive Endoscopy Unit, "Città della Salute e della Scienza" Hospital, Torino, Italy.

⁵Gastroenterology and Clinical Unit for Inflammatory Bowel Diseases, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.

⁶Unità Operativa Complessa di Gastroenterologia Cinica, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy.

⁷Gastroenterology and Endoscopy Unit, Azienda Ospedaliera Universitaria San Giovanni di Dio e Ruggi d'Aragona and University of Salerno, Salerno, Italy.

⁸Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.

⁹Gastroenterology Unit, Rho Hospital, Azienda Socio-Sanitaria Territoriale Rhodense, Rho (MI), Italy.

¹⁰Unità Operativa Complessa Gastroenterologia B, Azienda Ospedaliera Universitaria Integrata Policlinico G.B. Rossi & Dipartimento di Medicina, Università di Verona, Verona, Italy.

¹¹Inflammatory Bowel Disease Unit, Azienda Ospedaliera Ospedali Riuniti "Villa Sofia-Cervello" Palermo, Palermo, Italy.

¹²Department of Gastroenterology and Endoscopy, Fondazione "Casa Sollievo della Sofferenza", IRCCS, San Giovanni Rotondo, Italy.

¹³Gastroenterology Unit (Department of Emergency and Organ transplantation), University of Bari, Bari, Italy.

¹⁴Division of Gastroenterology, Department of Translational and Precision Medicine, "Sapienza" University of Rome and Umberto I Hospital, Rome, Italy.

¹⁵Gastroenterology Unit, Spedali Civili di Brescia and Department of Clinical and Sperimental Sciences, University of Brescia, Brescia, Italy.

¹⁶Gastroenterology and Endoscopy Unit, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy.

¹⁷Gastroenterology Unit, Department of Internal Medicine, Policlinico San Martino, Università di Genova, Genoa, Italy.

¹⁸Gastroenterology Unit, ASL Torino 3, Rivoli, Torino, Italy.

¹⁹Gastroenterology & Hepatology Unit, Perugia General Hospital and University of Perugia, Perugia, Italy.

²⁰Unit of Gastroenterology-Reference Center for IBD-Second University of Naples, Naples, Italy.

²¹Unità Operativa Complessa Gastroenterologia, Ospedale S. Maria del Prato, Azienda - Unità Locale Socio Sanitaria 1 Dolomiti, Feltre, Italy.

²²Department of Medicine and Ageing Sciences and Center for Advanced Studies and Technology (CAST), "G. d'Annunzio" University of Chieti-Pescara, Chieti-Pescara, Italy.

²³Gastroenterology and Endoscopy Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Cà Granda, Ospedale Maggiore Policlinico and Università degli Studi di Milano, Milan, Italy.

²⁴Gastroenterology and Digestive Endoscopy Unit, Azienda sanitaria universitaria Giuliano Isontina, Cattinara Academic Hospital, Trieste, Italy.

²⁵Department of Gastroenterology and Digestive Endoscopy, S. Croce e Carle Hospital, Cuneo, Italy.

²⁶UC Gastroenterologia, Dipartimento di Specialità Mediche, Azienda Ospedaliera Universitaria di Modena, Modena, Italy.

²⁷Istituto di Ricovero e Cura a Carattere Scientifico Humanitas Research Hospital, Rozzano, Milan, Italy.

²⁸Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.

²⁹Gastroenterologia, Fisiopatologia ed Endoscopia Digestiva, Azienda Sanitaria dell'Alto Adige, Bolzano, Italy.

³⁰Servizio di Epidemiologia Clinica & Biometria, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.

Abstract

Background: Anemia is a common extraintestinal manifestation of inflammatory bowel disease (IBD), with a 6% to 74% prevalence and a negative impact on patient survival and quality of life, although the prevalence is apparently declining due to improved disease treatment. We aimed to investigate the prevalence, pathogenesis, and clinical correlates of anemia in Italian patients with IBD.

Methods: A multicenter, prospective, observational study, involving 28 Italian gastroenterology centers, was conducted to investigate the epidemiology and consequences of IBD-associated anemia. Clinical and laboratory data of anemic patients were obtained at study enrolment.

Results: Anemia was diagnosed in 737 of 5416 adult IBD outpatients (prevalence 13.6%); females were more commonly affected than males (odds ratio, 1.5; 95% confidence interval [CI], 1.2-1.7) and had more severe anemia. In the majority of cases, anemia was due to iron deficiency (62.5% of cases; 95% CI, 58.3%-66.6%), either isolated or in association with inflammation and/or vitamin deficiencies; anemia of inflammation accounted for only 8.3% of cases. More severe anemia was associated with increasing fatigue and worse quality of life. Only 68.9% of anemic patients with iron deficiency (95% CI, 63.4%-73.8%) and 34.6% of those with vitamin deficiencies (95% CI, 26.2%-44.2%) were properly treated with supplementation therapy.

Conclusions: In Italy, the prevalence of IBD-associated anemia is lower than previously reported. Anemia of IBD is most commonly due to iron deficiency and contributes to fatigue and poor quality of life, but remains untreated in a large proportion of patients with iron and/or vitamin deficiencies. This study is registered at clinicaltrials.gov as NCT02872376.