Many UC Patients Do Not Receive Monitoring and Treatment for Iron Deficiency

Though iron-deficiency anemia (IDA) is a common complication of ulcerative colitis (UC), a study has found that about a third of UC patients with anemia are not even tested for iron deficiency and nearly a fourth of those diagnosed with IDA do not receive iron replacement therapy.

“Our study emphasizes the need to educate gastroenterologists and general practitioners to diagnose and treat iron deficiency anemia at an early stage," wrote the researchers.

The study, by Nabeel Khan, MD, of University of Pennsylvania Perelman School of Medicine (Philadelphia, PA, USA) and colleagues, used nationwide data on 836 patients newly diagnosed with UC in the Veterans Affairs (VA) health care system from 2001 to 2011. Over a median 8 years' follow-up, 70% of patients developed anemia. The researchers focused on how many of these patients were tested and treated for IDA, which has profound effects on health, including declines in physical and cognitive abilities.

The results showed "inadequate monitoring and treatment of anemia and iron deficiency" among UC patients. Of the patients who developed anemia, 31% did not undergo recommended tests for iron deficiency; 63% of patients tested were diagnosed with IDA. Only 76% of those diagnosed with IDA received recommended iron replacement therapy, leaving about 1/4th of patients untreated, despite testing and diagnosis.

All of the treated IDA patients received oral iron supplements – including patients with severe anemia, for which intravenous iron supplementation is the preferred treatment. Treatment rates increased with the severity of IDA: 55% in mild cases, compared to 76% in moderate and 91% in severe cases. "This finding...could explain the high prevalence of moderate to severe IDA in our population, as they were not treated during the early stage of their anemia," wrote Dr. Khan and coauthors.

They noted that, while based on nationwide data, the study population, being limited to patients in the VA system, may differ from the general population of UC patients.

Significant regional differences (in the USA) were also found: testing for IDA was less likely for patients in the Midwest and South regions, compared to the Northeast and West, possibly reflecting differences in physician awareness or patient follow-up care.

Given the high prevalence and health impact of IDA, the researchers recommended that testing and treatment for iron deficiency should be added to the UC care quality indicators listed by the Crohn's & Colitis Foundation of America (CCFA) and the American Gastroenterology Association. "Testing and treatment are both easily measurable parameters, and emphasizing their importance will lead to better patient outcomes," they wrote.

The study, by Khan N et al, was published online October 18, 2016, in the journal Inflammatory Bowel Diseases.

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University of Pennsylvania Perelman School of Medicine