Pathophysiology and therapeutic management of anemia in gastrointestinal disorders

Expert Rev Gastroenterol Hepatol. 2022 Jun 20;1-13. doi: 10.1080/17474124.2022.2089114.Online ahead of print.


Gaetano Bergamaschi 1Flavio Caprioli 2Marco Vincenzo Lenti 1 3Luca Elli 4Franco Radaelli 5Emanuele Rondonotti 5Caterina Mengoli 1Emanuela Miceli 1Chiara Ricci 6Sandro Ardizzone 7Maurizio Vecchi 2Antonio Di Sabatino 1 3


Author information

1Department of Internal Medicine, San Matteo Hospital Foundation, Pavia, Italy.

2Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico and Università degli Studi di Milano, Milan, Italy.

3Department of Internal Medicine, University of Pavia, Pavia, Italy.

4Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico of Milan, Milan, Italy.

5Gastroenterology Unit, Valduce Hospital, Como, Italy.

6Gastroenterology Unit, Spedali Civili di Brescia and Department of Clinical and Experimental Sciences, University of Brescia, Brescia Italy.

7Sacco, University of MilanGastroenterology and Digestive Endoscopy Unit, Department of Biochemical and Clinical Sciences L , Milano, Italy.


Introduction: Anemia is a common complication of gastrointestinal (GI) disorders, with a prevalence up to 60% in celiac disease (CeD) and inflammatory bowel disease (IBD). Iron deficiency anemia (IDA) is the most prevalent form of anemia in these conditions, but chronic inflammation and vitamin B12 deficiency represent other common contributing mechanisms, especially in IBD.

Areas covered: We discuss the pathogenesis of anemia in various medical GI disorders, the sometime problematic distinction between IDA, anemia of inflammation (AI) and the association of the two, and therapeutic and preventive measures that can be useful for the management of anemia in GI disorders. Unfortunately, with the exception of IDA and AI in IBD, large RCT concerning the treatment of anemia in GI disorders are lacking.

Expert opinion: Anemia management strategies in GI disorders are outlined, with a focus on the main prevention, diagnostic, and therapeutic measures. Specific problems and situations such as the role of gluten-free diet for IDA treatment in CeD, the choice between oral and parenteral supplementation of iron or vitamin B12 in carential anemias, the use of endoscopic procedures to stop bleeding in intestinal angiodysplasia and preventive/treatment strategies for NSAID-associated GI bleeding are discussed.



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