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European Consensus on the Diagnosis and Management of Iron Deficiency and Anaemia in Inflammatory Bowel Diseases

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Dignass, Axel U, Gasche, Christoph, Bettenworth, Dominik, Birgegård, Gunnar, Danese, Silvio, Gisbert, Javier P, Gomollon, Fernando, Iqbal, Tariq, Katsanos, Konstantinos, Koutroubakis, Ioannis, Magro, Fernando, Savoye, Guillaume, Stein, Jürgen, Vavricka, Stephan·2015·Journal of Crohn's and Colitis
DOI 10.1093/ecco-jcc/jju009
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Abstract

Anaemia is the most common systemic complication and extraintestinal manifestation of inflammatory bowel disease [IBD].1–3 In the majority of cases, IBD-associated anaemia is a unique example of the combination of chronic iron deficiency and anaemia of chronic disease [ACD].4,5 Other more rare causes of anaemia in IBD include vitamin B12 and folate deficiency, toxic effects of medications, and others. The impact of anaemia on the quality of life of IBD patients is substantial. It affects various aspects of quality of life such as physical, emotional, and cognitive functions, the ability to work, hospitalization, and healthcare costs.6 Anaemia in IBD is not just a laboratory marker; it is a complication of IBD that needs appropriate diagnostic and therapeutic approaches.3 Despite the broad use of anti-inflammatory therapy, anaemia may recur fast after successful therapy. As anaemia is a serious medical condition that may become life threatening [if blood transfusions are not available or compatible], preventive measures should be considered. Prevention of anaemia and maintenance of iron and vitamin stores are therefore warranted. The goal of this consensus initiated by the European Crohn’s and Colitis Organisation [ECCO] was to establish European consensus guidelines for the diagnosis, treatment and prevention of iron deficiency and iron deficiency anaemia [IDA], but also for non-iron deficiency anaemia and associated conditions. The consensus is based in parts on a previous evidence-based consensus publication on the diagnosis and management of iron deficiency and anaemia in inflammatory bowel diseases.7 The strategy to reach the consensus involved several steps and follows the standard operating procedures for consensus guidelines of ECCO. An open call for chairs and participants for this consensus was made [see acknowledgements and www.ecco-ibd]. Participants were selected by the Guidelines Committee of ECCO [GuiCom] on the basis of their publication record and a personal statement. Four working groups [WGs] were formed: WG 1 on Diagnosis of anaemia, WG 2 on Treatment of iron deficiency anaemia, WG 3 on Prevention of iron deficiency anaemia, and WG 4 on Management of non-iron deficiency anaemia. Participants were asked to answer relevant questions on current practise and areas of controversy related to the diagnosis and management of anaemia in IBD based on their experience as well as evidence from the literature [Delphi procedure].8 In parallel, the WG members performed a systematic literature search of their topic with the appropriate key words using Medline/PubMed/ISI/Scopus and the Cochrane database, as well as their own files. The evidence level [EL] was graded according to the Oxford Centre for Evidence-Based Medicine.9 Provisional guideline statements [with supporting text] were then written by the WG chairs, based upon answers to the questionnaire, and were circulated among the WG members, prompting discussions and exchange of literature evidence. The proposed statements and the supporting text were submitted to an online platform for online discussion and two online voting procedures, among all consensus participants for the first voting procedure and also for all national representatives of ECCO for the second voting procedure. The WGs finally met in Frankfurt on June 28, 2013 for a face-to-face discussion and to vote and consent on the statements. Technically this was done by projecting the statements and revising them on screen until a consensus was reached. Consensus was defined as agreement by more than 80% of participants, termed a Consensus Statement and numbered for convenience in the document. The final manuscript was written by the WG chairs in conjunction with the WG members and was revised for consistency by CG and AD. An update of this current consensus guideline is planned in about 4 years. The currently used WHO definition of anaemia [Table 1] applies also to patients with IBD. All patients with IBD should be assessed for the presence of anaemia. The major forms of anaemia in IBD are iron deficiency anaemia, anaemia of chronic disease and anaemia of mixed origin [EL 5] Minimum hemoglobin and hematocrit levels used to define anaemia in people living at sea level. 10 Minimum hemoglobin and hematocrit levels used to define anaemia in people living at sea level. 10 Normal hemoglobin varies with age and gender. Also other factors influence hemoglobin levels such as pregnancy, high altitudes, smoking, and ethnicity.11,12 The lower limits of normal hemoglobin concentration are even lower in African Americans [11.5g/dL for women, 12.9g/dL for men] and in the elderly. Interpretation of hemoglobin and hematocrit levels needs to consider such modulating factors. The definitions of anaemia in IBD is indifferent to other conditions and it is reasonable that WHO cut-offs apply.10 IBD patients should be regularly assessed for the presence of anaemia because of its high prevalence, its impact on qua

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  120. Sandborn, 2004, Pharmacogenomics and IBD: TPMT and thiopurines, Inflamm Bowel Dis, 10, S35, 10.1097/00054725-200402001-00008 · DOI

Cited by

See all 622

Metadata

Authors
Dignass, A. U., Gasche, C., Bettenworth, D., Birgegård, G., Danese, S., Gisbert, J. P., Gomollon, F., Iqbal, T., Katsanos, K., Koutroubakis, I., Magro, F., Savoye, G., Stein, J., & Vavricka, S.
Venue
Journal of Crohn's and Colitis
Publisher
Oxford University Press (OUP)
Published
2015-01-16
Volume
9
Issue
3
Pages
211-222
ISSN
  • 1873-9946 (ISSN-L)
  • 1876-4479
DOI
10.1093/ecco-jcc/jju009
OpenAlex
W2124903183
Cited by
622
References
10
FWCI
20.82
Type
journal article
Language
en
Open access
bronze

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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Data sources

Bibliographic data: Semantic Scholar, OpenAlex, Crossref.

Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).

Semantic Scholar’s data is described in: Kinney, R., et al. (2023). The Semantic Scholar Open Data Platform. arXiv:2301.10140.