Khan Nabeel, Patel Dhruvan, Shah Yash, Yang Yu-Xiao
*Section of Gastroenterology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; †Section of Gastroenterology, VA Medical Center, Philadelphia, Pennsylvania; and ‡Department of Internal Medicine, Mercy Catholic Medical Center, Darby, Pennsylvania.
Inflamm Bowel Dis. 2016 Dec;22(12):2894-2901. doi: 10.1097/MIB.0000000000000947.
Iron deficiency anemia (IDA) is an often unrecognized and undertreated complication of ulcerative colitis (UC). We conducted the first nationwide study in the United States to evaluate the prevalence of testing for iron deficiency (ID) in anemic UC patients and determine the frequency of treatment with iron supplementation in patients with IDA.
Nationwide cohort of patients with newly diagnosed UC in the Veterans Affairs health care system was identified. Primary outcome was to evaluate if anemic UC patients were tested for ID and subsequently treated with iron replacement therapy if IDA is confirmed. Candidate parameters included factors that can impact testing and treatment of anemia including patients' demographics, severity of anemia, and endoscopic findings.
Of 836 newly diagnosed patients with UC, 585 patients (70%) developed anemia over the course of median 8 years of follow-up. Of 585 patients, 401 patients (68.6%) had iron study evaluation. Two hundred fifty-one patients (62.6%) were diagnosed with IDA, and among them, 191 patients (76.1%) were treated with oral iron therapy. None of the patient received intravenous iron therapy. In multivariate analysis, patients with mild/moderate anemia and patients from Midwest and South region were independent predictors of iron study evaluation in patients with anemia.
More than a third of anemic UC patients were not tested for ID. Once tested, almost a quarter of the patients with IDA were not treated with iron replacement therapy. Testing for ID and subsequent treatment with iron replacement therapy should be considered among the quality process indicators in UC.
缺铁性贫血（IDA）是溃疡性结肠炎（UC）一种常未被识别和治疗不足的并发症。我们在美国开展了第一项全国性研究，以评估贫血性UC患者缺铁（ID）检测的患病率，并确定IDA患者铁补充治疗的频率。
在退伍军人事务医疗系统中确定全国范围内新诊断的UC患者队列。主要结局是评估贫血性UC患者是否进行了ID检测，以及如果确诊为IDA是否随后接受铁替代治疗。候选参数包括可能影响贫血检测和治疗的因素，包括患者的人口统计学特征、贫血严重程度和内镜检查结果。
在836例新诊断的UC患者中，585例患者（70%）在中位8年的随访期间出现贫血。在585例患者中，401例患者（68.6%）进行了铁代谢评估。251例患者（62.6%）被诊断为IDA，其中191例患者（76.1%）接受了口服铁剂治疗。没有患者接受静脉铁剂治疗。在多变量分析中，轻度/中度贫血患者以及来自中西部和南部地区的患者是贫血患者进行铁代谢评估的独立预测因素。
超过三分之一的贫血性UC患者未进行ID检测。一旦进行检测，近四分之一的IDA患者未接受铁替代治疗。在UC的质量过程指标中应考虑ID检测及随后的铁替代治疗。
