title: Persistent or Recurrent Anemia Is Associated With Severe and Disabling Inflammatory Bowel Disease.
abstract: OBJECTIVE
  Anemia is a common manifestation of inflammatory bowel disease (IBD) that can greatly affect patients' quality of life. We performed a prospective study of a large cohort of patients with IBD to determine if patterns of anemia over time are associated with aggressive or disabling disease.
  
  
  METHODS
  We performed a longitudinal analysis of demographic, clinical, laboratory, and treatment data from a registry of patients with IBD at the University of Pittsburgh Medical Center from 2009 through 2013. Patients with a complete follow-up evaluation (at least 1 annual visit with laboratory results) were included. Anemia was defined by World Health Organization criteria. Disease activity scores (the Harvey-Bradshaw Index or the ulcerative colitis activity index) and quality-of-life scores (based on the short IBD questionnaire) were determined at each visit; laboratory data, including levels of C-reactive protein and erythrocyte sedimentation rates, as well as patterns of IBD-related health care use, were analyzed.
  
  
  RESULTS
  A total of 410 IBD patients (245 with Crohn's disease, 165 with ulcerative colitis; 50.5% female) were included. The prevalence of anemia in patients with IBD was 37.1% in 2009 and 33.2% in 2013. Patients with IBD and anemia required significantly more health care and had higher indices of disease activity, as well as a lower average quality of life, than patients without anemia (P < .0001). Anemia (persistent or recurrent) for 3 or more years was correlated independently with hospitalizations (P < .01), visits to gastroenterology clinics (P < .001), telephone calls (P < .004), surgeries for IBD (P = .01), higher levels of C-reactive protein (in patients with ulcerative colitis, P = .001), and a higher erythrocyte sedimentation rate (P < .0001). Anemia was correlated negatively with quality-of-life scores (P < .03).
  
  
  CONCLUSIONS
  Based on a longitudinal analysis of 410 patients, persistent or recurrent anemia correlates with more aggressive or disabling disease in patients with IBD.
authors: Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors: Ioannis E
authors: IE
authors: Koutroubakis
authors: Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors: Claudia
authors: C
authors: Ramos-Rivers
authors: Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors: Miguel
authors: M
authors: Regueiro
authors: Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors: Efstratios
authors: E
authors: Koutroumpakis
authors: Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors: Benjamin
authors: B
authors: Click
authors: Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors: Robert E
authors: RE
authors: Schoen
authors: Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors: Jana G
authors: JG
authors: Hashash
authors: Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors: Marc
authors: M
authors: Schwartz
authors: Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors: Jason
authors: J
authors: Swoger
authors: Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors: Leonard
authors: L
authors: Baidoo
authors: Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors: Arthur
authors: A
authors: Barrie
authors: Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors: Michael A
authors: MA
authors: Dunn
authors: Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. Electronic address: binion@pitt.edu.
authors: David G
authors: DG
authors: Binion
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000150:complications* / Q000473:pathology*; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000032:analysis; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications* / Q000473:pathology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania; D011446:Prospective Studies; D011788:Quality of Life; D012008:Recurrence; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D002097:C-Reactive Protein
keywords: C-Reactive Protein; Crohn's Disease; Erythrocyte Sedimentation Rate; Quality of Life; Ulcerative Colitis