From The Abraham and Sonia Rochlin IBD Unit, Department of Gastroenterology and Liver Diseases, Emek Medical Center, Afula, Israel.
The Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
J Pediatr Gastroenterol Nutr. 2023 Nov 1;77(5):634-639. doi: 10.1097/MPG.0000000000003913. Epub 2023 Aug 15.
The consensus guidelines of the European Crohn's and Colitis Organization (ECCO) for the diagnosis and treatment of iron deficiency anemia (IDA) were published in 2015. We examined the management practices of both adult gastroenterologists (AGs) and pediatric gastroenterologists (PGs) in Israel in treating ID among patients with inflammatory bowel disease (IBD).
An 18-question multiple-choice anonymous questionnaire was electronically delivered to AGs and PGs. Questions explored 3 areas of interest: physician demographics, adherence to ECCO guidelines, and management practices of IDA in patients with IBD.
Completed questionnaires were returned by 72 AGs and 89 PGs. Practice setting and years of practice were similar. A large majority of AGs and PGs (89% and 92%, respectively) measure complete blood count (CBC) and serum ferritin (S-Fr) at least every 3 months in outpatients with active IBD, as recommended by the ECCO guidelines. In contrast, in IBD patients in remission, only 53% and 26% of AGs and PGs, respectively ( P < 0.001), reported adherence to ECCO guidelines, measuring CBC and S-Fr every 6 months. The ECCO treatment guidelines recommend that intravenous (IV) iron should be considered the first-line treatment in patients with clinically active IBD, with previous oral iron intolerance and those with a hemoglobin level <10 g/dL. Study results indicate that only 43% of AGs recommend IV iron for these indications, compared to 54% of PGs ( P > 0.1).
In this study we have demonstrated a relatively low level of adherence to ECCO guideline recommendations among both AGs and PGs, regarding the management of IDA in patients with IBD.
欧洲克罗恩病和结肠炎组织（ECCO）的缺铁性贫血（IDA）诊断和治疗共识指南于 2015 年发布。我们检查了以色列成人胃肠病学家（AGs）和儿科胃肠病学家（PGs）在治疗炎症性肠病（IBD）患者 IDA 方面的管理实践。
通过电子方式向 AGs 和 PGs 发送了一份包含 18 个问题的多项选择匿名问卷。问题涉及三个感兴趣的领域：医生人口统计学，对 ECCO 指南的遵守情况以及 IBD 患者 IDA 的管理实践。
72 名 AGs 和 89 名 PGs 完成了调查问卷。实践环境和从业年限相似。绝大多数 AGs 和 PGs（分别为 89%和 92%）至少每 3 个月对活动期 IBD 的门诊患者进行全血细胞计数（CBC）和血清铁蛋白（S-Fr）检测，这符合 ECCO 指南的建议。相比之下，在缓解期的 IBD 患者中，只有 53%和 26%的 AGs 和 PGs（P<0.001）分别报告了对 ECCO 指南的遵守情况，即每 6 个月检测 CBC 和 S-Fr。ECCO 治疗指南建议，对于有临床活动性 IBD、既往口服铁不耐受和血红蛋白水平<10g/dL 的患者，应考虑静脉（IV）铁作为一线治疗。研究结果表明，只有 43%的 AGs 建议对这些患者使用 IV 铁，而 PGs 中有 54%（P>0.1）。
在这项研究中，我们发现无论是 AGs 还是 PGs，在治疗 IBD 患者的 IDA 方面，对 ECCO 指南建议的遵循程度相对较低。
