The burden and management of anemia in Greek patients with inflammatory bowel disease: a retrospective, multicenter, observational study
Authors: Foteinogiannopoulou Kalliopi , Karmiris Konstantinos , Axiaris Georgios , Velegraki Magdalini , Gklavas Antonios , Kapizioni Christina , Karageorgos Charalabos , Kateri Christina , Katsoula Anastasia , Kokkotis Georgios , Koureta Evgenia , Lamouri Charikleia , Markopoulos Panagiotis , Palatianou Maria , Pastras Ploutarchos , Fasoulas Konstantinos , Giouleme Olga , Zampeli Evanthia , Theodoropoulou Aggeliki , Theocharis Georgios , Thomopoulos Konstantinos , Karatzas Pantelis , Katsanos Konstantinos H. , Kapsoritakis Andreas , Kourikou Anastasia , Mathou Nikoleta , Manolakopoulos Spilios , Michalopoulos Georgios , Michopoulos Spyridon , Boubonaris Alexandros , Bamias Giorgos , Papadopoulos Vasileios , Papatheodoridis George , Papaconstantinou Ioannis , Pachiadakis Ioannis , Soufleris Konstantinos , Tzouvala Maria , Triantos Christos , Tsironi Eftychia , Christodoulou Dimitrios K. , Koutroubakis Ioannis E. ,   the Hellenic group for the study of IBD, Foteinogiannopoulou Kalliopi , Karmiris Konstantinos , Axiaris Georgios , Velegraki Magdalini , Gklavas Antonios , Kapizioni Christina , Karageorgos Charalabos , Kateri Christina , Katsoula Anastasia , Kokkotis Georgios , Koureta Evgenia , Lamouri Charikleia , Markopoulos Panagiotis , Palatianou Maria , Pastras Ploutarchos , Fasoulas Konstantinos , Giouleme Olga , Zampeli Evanthia , Theodoropoulou Aggeliki , Theocharis Georgios , Thomopoulos Konstantinos , Karatzas Pantelis , Katsanos Konstantinos H. , Kapsoritakis Andreas , Kourikou Anastasia , Mathou Nikoleta , Manolakopoulos Spilios , Michalopoulos Georgios , Michopoulos Spyridon , Boubonaris Alexandros , Bamias Giorgos , Papadopoulos Vasileios , Papatheodoridis George , Papaconstantinou Ioannis , Pachiadakis Ioannis , Soufleris Konstantinos , Tzouvala Maria , Triantos Christos , Tsironi Eftychia , Christodoulou Dimitrios K. , Koutroubakis Ioannis E. 
Published: June 2021

Abstract
Background
Anemia is a common extraintestinal manifestation of Inflammatory Bowel Disease (IBD) affecting negatively the patients’ quality of life. The aim of this study was to determine the frequency and real-life management of anemia in IBD patients in Greece.

Methods
This study was conducted in 17 Greek IBD referral centers. Demographic, clinical, laboratory, IBD and anemia treatment data were collected and analyzed retrospectively.

Results
A total of 1394 IBD patients [560 ulcerative colitis (UC), 834 Crohn’s disease (CD)] were enrolled. Anemia at any time was reported in 687 (49.3%) patients of whom 413 (29.6%) had episodic and 274 (19.7%) had recurrent/persistent anemia. Anemia was diagnosed before IBD in 45 (6.5%), along with IBD in 269 (39.2%) and after IBD in 373 (54.3%) patients. In the multivariate analysis the presence of extraintestinal manifestations (p = 0.0008), IBD duration (p = 0.026), IBD related surgeries and hospitalizations (p = 0.026 and p = 0.004 accordingly) were risk factors of recurrent/persistent anemia. Serum ferritin was measured in 839 (60.2%) IBD patients. Among anemic patients, 535 (77.9%) received treatment. Iron supplementation was administered in 485 (90.6%) patients, oral in 142 (29.3%) and intravenous in 393 (81%).

Conclusions
The frequency of anemia in IBD patients, followed at Greek referral centers, is approximately 50%. Development of recurrent/persistent anemia may be observed in 20% of cases and is independently associated with the presence of extraintestinal manifestations, IBD duration, IBD related surgeries and hospitalizations. Anemia treatment is administered in up to $$4/5$$

4
/
5

of anemia IBD patients with the majority of them receiving iron intravenously.