Browse > Article
http://dx.doi.org/10.5223/pghn.2019.22.2.152

Anemia Screening, Prevalence, and Treatment in Pediatric Inflammatory Bowel Disease in the United States, 2010-2014  

Miller, Steven D. (Division of Pediatric Gastroenterology & Hepatology, Johns Hopkins University School of Medicine)
Cuffari, Carmelo (Division of Pediatric Gastroenterology & Hepatology, Johns Hopkins University School of Medicine)
Akhuemonkhan, Eboselume (Department of Allopathic Internal Medicine Residency, The Wright Center for Graduate Medical Education)
Guerrerio, Anthony L. (Division of Pediatric Gastroenterology & Hepatology, Johns Hopkins University School of Medicine)
Lehmann, Harold (Division of Health Science Informatics, Johns Hopkins University School of Medicine)
Hutfless, Susan (Division of Gastroenterology & Hepatology, Johns Hopkins University School of Medicine)
Publication Information
Pediatric Gastroenterology, Hepatology & Nutrition / v.22, no.2, 2019 , pp. 152-161 More about this Journal
Abstract
Purpose: We examined the prevalence of anemia, annual screening for anemia, and treatment of anemia with iron among children with inflammatory bowel disease (IBD). Methods: A retrospective study of U.S. pediatric patients with IBD was performed in the MarketScan commercial claims database from 2010-2014. Children (ages 1-21) with at least two inpatient or outpatient encounters for IBD who had available lab and pharmacy data were included in the cohort. Anemia was defined using World Health Organization criteria. We used logistic regression to determine differences in screening, incident anemia, and treatment based on age at first IBD encounter and sex. Results: The cohort (n=2,446) included 1,560 Crohn's disease (CD) and 886 ulcerative colitis (UC). Approximately, 85% of CD and 81% of UC were screened for anemia. Among those screened, 51% with CD and 43% with UC had anemia. Only 24% of anemia patients with CD and 20% with UC were tested for iron deficiency; 85% were iron deficient. Intravenous (IV) iron was used to treat 4% of CD and 4% UC patients overall and 8% of those with anemia. Conclusion: At least 80% of children with IBD were screened for anemia, although most did not receive follow-up tests for iron deficiency. The 43%-50% prevalence of anemia was consistent with prior studies. Under-treatment with IV iron points to a potential target for quality improvement.
Keywords
Crohn disease; Screening; Ulcerative colitis; Anemia; Iron-deficiency;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Wiskin AE, Fleming BJ, Wootton SA, Beattie RM. Anaemia and iron deficiency in children with inflammatory bowel disease. J Crohns Colitis 2012;6:687-91.   DOI
2 Wikholm E, Malmborg P, Forssberg M, Hederos CA, Wikstrom S. Iron deficiency is common during remission in children with inflammatory bowel disease. Glob Pediatr Health 2016;4:2333794X16633672.
3 Burbige EJ, Huang SH, Bayless TM. Clinical manifestations of Crohn's disease in children and adolescents. Pediatrics 1975;55:866-71.
4 Beeken WL. Absorptive defects in young people with regional enteritis. Pediatrics 1973;52:69-74.
5 Thayu M, Leonard MB, Baldassano RN, Mamula P. Prevalence of anemia in incident pediatric crohn disease: 177. J Pediatr Gastroenterol Nutr 2005:41:547-8.
6 Antunes CV, Hallack Neto AE, Nascimento CR, Chebli LA, Moutinho IL, Pinheiro BV, et al. Anemia in inflammatory bowel disease outpatients: prevalence, risk factors, and etiology. BioMed Res Int 2015;2015:728925.
7 Filmann N, Rey J, Schneeweiss S, Ardizzone S, Bager P, Bergamaschi G, et al. Prevalence of anemia in inflammatory bowel diseases in European countries: a systematic review and individual patient data meta-analysis. Inflamm Bowel Dis 2014;20:936-45.   DOI
8 Akhuemonkhan E, Parian A, Miller K, Hanauer S, Hutfless S. Prevalence and screening for anaemia in mild to moderate Crohn's disease and ulcerative colitis in the United States, 2010-2014. BMJ Open Gastroenterol 2017;4:e000155.   DOI
9 Blumenstein I, Dignass A, Vollmer S, Klemm W, Weber-Mangal S, Stein J. Current practice in the diagnosis and management of IBD-associated anaemia and iron deficiency in Germany: the German AnaemIBD Study. J Crohns Colitis 2014;8:1308-14.   DOI
10 Benchimol EI, Fortinsky KJ, Gozdyra P, Van den Heuvel M, Van Limbergen J, Griffiths AM. Epidemiology of pediatric inflammatory bowel disease: a systematic review of international trends. Inflamm Bowel Dis 2011;17:423-39.   DOI
11 Kelsen J, Baldassano RN. Inflammatory bowel disease: the difference between children and adults. Inflamm Bowel Dis 2008;14 Suppl 2:S9-11.
12 Uhlig HH, Schwerd T, Koletzko S, Shah N, Kammermeier J, Elkadri A, et al. The diagnostic approach to monogenic very early onset inflammatory bowel disease. Gastroenterology 2014;147:990-1007.e3.   DOI
13 Danese S, Hoffman C, Vel S, Greco M, Szabo H, Wilson B, et al. Anaemia from a patient perspective in inflammatory bowel disease: results from the European Federation of Crohn's and Ulcerative Colitis Association's online survey. Eur J Gastroenterol Hepatol 2014;26:1385-91.   DOI
14 Wells CW, Lewis S, Barton JR, Corbett S. Effects of changes in hemoglobin level on quality of life and cognitive function in inflammatory bowel disease patients. Inflamm Bowel Dis 2006;12:123-30.   DOI
15 McCann JC, Ames BN. An overview of evidence for a causal relation between iron deficiency during development and deficits in cognitive or behavioral function. Am J Clin Nutr 2007;85:931-45.   DOI
16 Ott C, Liebold A, Takses A, Strauch UG, Obermeier F. High prevalence but insufficient treatment of iron-deficiency anemia in patients with inflammatory bowel disease: results of a population-based cohort. Gastroenterol Res Pract 2012;2012:595970.   DOI
17 Hansen LG, Stella C. Health research data for the real world: the MarketScan databases [Internet]. Ann Arbor (MI): Truven Health Analytics; 2011 [cited 2016 Nov 11]. Available from: http://truvenhealth.com/portals/0/assets/PH_11238_0612_TEMP_MarketScan_WP_FINAL.pdf.
18 Regenstrief Institute. LOINC and RELMA complete package [Internet]. Indianapolis (IN): Regenstrief Institute; 2017 [cited 2017 Oct 10]. Available from: https://loinc.org/downloads/relma/.
19 Mucke V, Mucke MM, Raine T, Bettenworth D. Diagnosis and treatment of anemia in patients with inflammatory bowel disease. Ann Gastroenterol 2017;30:15-22.
20 Dignass AU, Gasche C, Bettenworth D, Birgegard G, Danese S, Gisbert JP, et al. European consensus on the diagnosis and management of iron deficiency and anaemia in inflammatory bowel diseases. J Crohns Colitis 2015;9:211-22.   DOI
21 Gasche C, Berstad A, Befrits R, Beglinger C, Dignass A, Erichsen K, et al. Guidelines on the diagnosis and management of iron deficiency and anemia in inflammatory bowel diseases. Inflamm Bowel Dis 2007;13:1545-53.   DOI
22 Alleyne M, Horne MK, Miller JL. Individualized treatment for iron-deficiency anemia in adults. Am J Med 2008;121:943-8.   DOI
23 Goodhand JR, Kamperidis N, Rao A, Laskaratos F, McDermott A, Wahed M, et al. Prevalence and management of anemia in children, adolescents, and adults with inflammatory bowel disease. Inflamm Bowel Dis 2012;18:513-9.   DOI
24 Valerio de Azevedo S, Maltez C, Lopes AI. Pediatric Crohn's disease, iron deficiency anemia and intravenous iron treatment: a follow-up study. Scand J Gastroenterol 2017;52:29-33.   DOI
25 World Health Organization; United Nations Children's Fund; United Nations University. Iron deficiency anemia: assessment, prevention and control [Internet]. Geneva: World Health Organization; 2001 [cited 2017 Oct 22]. Available from: http://www.who.int/nutrition/publications/en/ida_assessment_prevention_control.pdf.
26 Rufo PA, Denson LA, Sylvester FA, Szigethy E, Sathya P, Lu Y, et al. Health supervision in the management of children and adolescents with IBD: NASPGHAN recommendations. J Pediatr Gastroenterol Nutr 2012;55:93-108.   DOI
27 de Silva AD, Tsironi E, Feakins RM, Rampton DS. Efficacy and tolerability of oral iron therapy in inflammatory bowel disease: a prospective, comparative trial. Aliment Pharmacol Ther 2005;22:1097-105.   DOI
28 Avni T, Bieber A, Steinmetz T, Leibovici L, Gafter-Gvili A. Treatment of anemia in inflammatory bowel disease--systematic review and meta-analysis. PLoS One 2013;8:e75540.   DOI
29 Stein RE, Plantz K, Maxwell EC, Mamula P, Baldassano RN. Intravenous iron sucrose for treatment of iron deficiency anemia in pediatric inflammatory bowel disease. J Pediatr Gastroenterol Nutr 2018;66:e51-5.   DOI
30 Danko I, Weidkamp M. Correction of iron deficiency anemia with intravenous iron sucrose in children with inflammatory bowel disease. J Pediatr Gastroenterol Nutr 2016;63:e107-11.   DOI
31 Sjoberg D, Holmstrom T, Larsson M, Nielsen AL, Holmquist L, Ronnblom A. Anemia in a population-based IBD cohort (ICURE): still high prevalence after 1 year, especially among pediatric patients. Inflamm Bowel Dis 2014;20:2266-70.   DOI
32 Gryboski JD. Crohn's disease in children 10 years old and younger: comparison with ulcerative colitis. J Pediatr Gastroenterol Nutr 1994;18:174-82.   DOI
33 Gerasimidis K, Barclay A, Papangelou A, Missiou D, Buchanan E, Tracey C, et al. The epidemiology of anemia in pediatric inflammatory bowel disease: prevalence and associated factors at diagnosis and follow-up and the impact of exclusive enteral nutrition. Inflamm Bowel Dis 2013;19:2411-22.   DOI
34 White JM, O'Connor S, Winter HS, Heyman MB, Kirschner BS, Ferry GD, et al. Inflammatory bowel disease in African American children compared with other racial/ethnic groups in a multicenter registry. Clin Gastroenterol Hepatol 2008;6:1361-9.   DOI
35 Mack DR, Langton C, Markowitz J, LeLeiko N, Griffiths A, Bousvaros A, et al. Laboratory values for children with newly diagnosed inflammatory bowel disease. Pediatrics 2007;119:1113-9.   DOI
36 Howarth LJ, Wiskin AE, Griffiths DM, Afzal NA, Beattie RM. Outcome of childhood ulcerative colitis at 2 years. Acta Paediatr 2007;96:1790-3.   DOI
37 Khan K, Schwarzenberg SJ, Sharp H, Greenwood D, Weisdorf-Schindele S. Role of serology and routine laboratory tests in childhood inflammatory bowel disease. Inflamm Bowel Dis 2002;8:325-9.   DOI
38 Revel-Vilk S, Tamary H, Broide E, Zoldan M, Dinari G, Zahavi I, et al. Serum transferrin receptor in children and adolescents with inflammatory bowel disease. Eur J Pediatr 2000;159:585-9.   DOI
39 Thomas DW, Sinatra FR. Screening laboratory tests for Crohn's disease. West J Med 1989;150:163-4.
40 Van Biervliet S, Smets F, Hofmann I, Degreef E, Hauser B, Bontems P, et al. The course of anaemia in children and adolescents with Crohn's disease included in a prospective registry. Int J Colorectal Dis 2015;30:51-6.   DOI