Systematic review: managing anaemia in Crohn's disease.
BACKGROUND
Anaemia is a serious complication of Crohn's disease that triggers hospitalization and, if not interfered with, may lead to death.


OBJECTIVE
To systematically summarize and compare the literature on anaemia in Crohn's disease.


METHODS
For this systematic review the literature was searched for English-language articles using anaemia, Crohn* and IBD as key words. 144 articles were identified and sorted according to the following topics: prevalence, aetiology, diagnostic tests and therapy.


RESULTS
The reported prevalence of anaemia varied between 6.2% and 73.7%, with higher reported frequencies in older studies and in in-patients. Iron deficiency is the most common underlying condition. Vitamin B12 deficiency is related to the extent of ileal resection but has rarely impact on anaemia. Diagnostic criteria are not established and treatment guidelines are missing. Oral iron supplementation seems effective for short periods but intolerance leads to discontinuation in up to 21%. Eleven of 11 studies show that oral iron enhances intestinal inflammation and colon carcinogenesis in animal models of colitis. Intravenous iron supplementation with iron sucrose has been tested in over 250 Crohn's disease patients, is safe, effective and does not carry such hazards.


CONCLUSIONS
As disease activity is determining the degree of anaemia in Crohn's disease, implementation of more effective therapy for Crohn's disease will lower its incidence. However, further studies regarding the safety and effectiveness of iron supplementation are needed.
Kulnigg
S
S
Department of Medicine, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria.
Gasche
C
C
D000740:Anemia / Q000188:drug therapy / Q000209:etiology*; D003424:Crohn Disease / Q000150:complications*; D005290:Ferric Compounds / Q000627:therapeutic use*; D005492:Folic Acid / Q000627:therapeutic use*; D005494:Folic Acid Deficiency / Q000175:diagnosis; D020022:Genetic Predisposition to Disease; D006801:Humans; D014805:Vitamin B 12 / Q000627:therapeutic use; D014806:Vitamin B 12 Deficiency / Q000175:diagnosis
D005290:Ferric Compounds; D005492:Folic Acid; D014805:Vitamin B 12