Adherence to ECCO Guidelines for Management of Iron Deficiency and Anemia in Inflammatory Bowel Diseases Among Israeli Adult and Pediatric Gastroenterologists

J Pediatr Gastroenterol Nutr. 2023 Aug 21. doi: 10.1097/MPG.0000000000003913.Online ahead of print.


Yotam Elimeleh 1Eran Zittan 1 2M Levy 1 2Firas Rinawi 3


Author information

1The Abraham and Sonia Rochlin IBD Unit, Department of Gastroenterology and Liver Diseases, Emek Medical Center, Afula, Israel.

2The Rappaport Faculty of Medicine Technion-Israel Institute of Technology, Haifa, Israel.

3Pediatric Gastroenterology Unit, Emek Medical Centre, Afula, Israel, Faculty of Medicine, Technion, Haifa, Israel.


Objectives: The consensus guidelines of the European Crohn's and Colitis Organization (ECCO) for the diagnosis and treatment of iron deficiency anemia (IDA), were published in 2015. We examined the management practices of both adult gastroenterologists (AGs) and pediatric gastroenterologists (PGs) in Israel in treating ID among patients with inflammatory bowel disease (IBD).

Methods: An 18-question multiple-choice anonymous questionnaire was electronically delivered to AGs and APs. Questions explored three areas of interest: physician demographics, adherence to ECCO guidelines, and management practices of IDA in patients with IBD.

Results: Completed questionnaires were returned by 72 AGs and 89 PGs. Practice setting and years of practice were similar. A large majority of AGs and PGs (89% and 92%, respectively) measure complete blood count (CBC) and serum ferritin (S-Fr) at least every three months in outpatients with active IBD, as recommended by the ECCO guidelines. In contrast, in IBD patients in remission, only 53% and 26% of AGs and PGs, respectively (p<0.001), reported adherence to ECCO guidelines, measuring CBC and S-Fr every six months. The ECCO treatment guidelines recommend that intravenous (IV) iron should be considered the first-line treatment in patients with clinically active IBD, with previous oral iron intolerance and those with a hemoglobin level <10g/dL. Study results indicate that only 43% of AGs recommend IV iron for these indications, compared to 54% of PGs (p>0.1).

Conclusions: In this study we have demonstrated a relatively low level of adherence to ECCO guideline recommendations among both AGs and PGs, regarding the management of IDA in patients with IBD.

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