炎症性肠病相关贫血的诊断与处理进展

贫血是炎症性肠病(IBD)常见且易被忽略的并发症,与IBD患者疾病转归和生活质量相关。IBD常见贫血类型为缺铁性贫血、慢性病性贫血和混合型。近年,IBD相关贫血的诊断和治疗均取得了进步。本文就IBD相关贫血诊断和治疗的进展作一综述。     

炎症性肠病相关贫血的诊治进展

<正>炎症性肠病(inflammatory bowel disease, IBD)是一种病因及发病机制尚未明确的慢性胃肠道非特异性炎症性疾病,包括溃疡性结肠炎(ulcerative colitis, UC)和克罗恩病(crohn disease, CD)。贫血是IBD患者最常见的肠外表现^[1],可发生在IBD病程的任何阶段,与疾病活动有关,但也可发生在无疾病活动阶段^[2]。IBD患者贫血的总体患病率约24%^[3],     

炎症性肠病合并贫血的研究进展

贫血是炎症性肠病(IBD)患者常见的并发症之一,会导致生活质量下降,也可增加患者的住院频率。据报道IBD并发贫血的发病率为6～74[1]。IBD患者贫血的发病机制尚未完全明了,铁摄入与丢失的负平衡、慢性病所致贫血、VitB12和叶酸缺乏、药物介导、炎症因子、溶血等众多因素均可能参与贫血的发生。过去普遍认为贫血是IBD不可避免的伴随症状,往往重视度不够,但最近的观点强调,贫血是此类患者明确的治疗内容。     

羧基麦芽糖铁治疗炎症性肠病并发缺铁性贫血的临床安全性及有效性研究

[目的]探讨静脉注射羧基麦芽糖铁治疗炎症性肠病患者的安全性和有效性。[方法]选取2015-11-2017-11期间因口服铁剂治疗失败,在本院接受羧基麦芽糖铁(总补铁剂量≤1 500 mg)静脉注射治疗缺铁性贫血的炎症性肠病患者72例,观察其治疗前及治疗4、8、12周后临床疗效及不良反应。[结果]72例静脉注射羧基麦芽糖铁治疗12周后,血红蛋白(Hb)水平平均升高21.96 g/L,红细胞平均体积(MCV)水平平均升高6.27 fl,血清铁蛋白平均升高24.46μg/L,与治疗前相比均差异有统计学意义(P0.05)。静脉补铁的剂量与IBD的类型是Hb升高的影响因素,静脉补铁1 000 mg的患者比≤1 000 mg的患者的Hb更易上升20 g/L(OR:4.28;95%CI:2.34～9.82,P0.001)。72例中6例(8.33%)在静脉补铁过程中出现了不良反应,与口服铁剂的不良反应发生率(20.83%)比较差异有统计学意义(P=0.034)。[结论]羧基麦芽糖铁静脉制剂可显著提高炎症性肠病患者Hb和MCV水平,耐受性好,是治疗炎症性肠病患者缺铁性贫血的有效和安全的方法。     

炎症性肠病合并贫血的研究进展

<正>贫血是炎症性肠病(inflammatory bowel disease IBD)患者常见且严重的并发症。IBD合并贫血给IBD治疗带来困难,增加患者的住院率,降低患者生活质量。IBD合并贫血机制尚不明确,目前的研究表明铁缺乏贫血(iron deficiency anemia,IDA)、慢性病性贫血(anemia of chronic disease,     

溃疡性结肠炎患者骨代谢生化指标检测及其临床意义

炎症性肠病(inflammatory bowel disease,IBD)不仅可导致消化道黏膜损伤,还可引起多种全身并发症.骨质疏松(osteoporosis,OP)是IBD患者常见且易被忽视的并发症之一.研究表明IBD患者OP发生率为15％,骨量减少发生率为18％[1].IBD患者易出现骨质丢失.     

炎性肠病关节炎发病机制新进展

炎症性肠病(inflammatory bowel disease,IBD)包括溃疡性结肠炎(ulcerative colitis,UC)和克罗恩病,在疾病活动期可以出现高达40％的肠外表现,其中合并风湿病表现的患者约有30％,是IBD最常见的肠外表现[1].郑连鹏等[2]对我国大陆地区炎性肠病肠外表现分析显示,UC和克罗恩病骨关节病变的发生率分别为5.12％和7.49％.     

细胞因子在炎症性肠病肠壁纤维化机制中的作用

炎症性肠病(inflammatory bowel disease,IBD)是病因复杂、反复发作的慢性非特异性肠道炎性疾病,包括克罗恩病(Crohn' 5 disease,CD)和溃疡性结肠炎(ulcerative colitis,UC).IBD长期病程可导致多种并发症,肠纤维化是常见而严重的并发症之一.CD患者常因肠狭窄而接受手术治疗,且肠切除术后还可能再次发生肠狭窄[1].     

炎症性肠病患者的营养问题

<正>炎症性肠病(inflammatory bowel disease,IBD),包括克罗恩病(Crohn disease,CD)和溃疡性结肠炎(inflammation colitis,UC)以及多种炎症性并发症性病变在内。IBD以往是北美与欧洲国家的常见肠病[1]。近30年日本IBD发病率增高。我国近10年来随着生活方式和饮食结构的改变,IBD就诊人数呈明显增高趋势,已成为我国常见的消化系疾病[1~3]。迄今,IBD的发病原因仍未明确,但胃肠道是人体进行正常消化、吸收与维持机体良好营养状态的中枢性器     

炎症性贫血的诊断与治疗

<正>炎症性贫血(anemia of inflammation,AI)也被称为慢性病贫血,是老年人和慢性病患者最常见的贫血原因之一。AI发病率居贫血发病原因的第2位,仅次于缺铁性贫血[1]。AI与慢性感染、风湿病和癌症等有关,也包括慢性肾性贫血、充血性心力衰竭以及器官移植引起的贫血,老年人特发性贫血常有AI的典型表现,但是否为AI,有待进一步研究。在AI患者中,71%患有急性感染,12%患有癌症,16%患有慢性感染或自身免疫性疾病[2]。     

Iron deficiency anemia in inflammatory bowel disease

Anemia is a common extraintestinal manifestation of inflammatory bowel disease(IBD) and is frequently overlooked as a complication. Patients with IBD are commonly found to have iron deficiency anemia(IDA) secondary to chronic blood loss, and impaired iron absorption due to tissue inflammation. Patients with iron deficiency may not always manifest with signs and symptoms; so, hemoglobin levels in patients with IBD must be regularly monitored for earlier detection of anemia. IDA in IBD is associated with poor quality of life, necessitating prompt diagnosis and appropriate treatment. IDA is often associated with inflammation in patients with IBD. Thus, commonly used labora-tory parameters are inadequate to diagnose IDA, and newer iron indices, such as reticulocyte hemoglobin content or percentage of hypochromic red cells or zinc protoporphyrin, are required to differentiate IDA from anemia of chronic disease. Oral iron preparations are available and are used in patients with mild disease activity. These preparations are inexpensive and con-venient, but can produce gastrointestinal side effects, such as abdominal pain and diarrhea, that limit their use and patient compliance. These preparations are partly absorbed due to inflammation. Non-absorbed iron can be toxic and worsen IBD disease activity. Although cost-effective intravenous iron formulations are widely available and have improved safety profiles, physicians are reluctant to use them. We present a review of the pathophysiologic mechanisms of IDA in IBD, improved diagnostic and therapeutic strategies, efficacy, and safety of iron replacement in IBD.     

Diagnosis and management of iron deficiency anemia in patients with IBD

Anemia is the most prevalent extraintestinal complication of IBD. It can affect quality of life and ability to work, and can also increase the hospitalization rate in patients with IBD. Although the causes of anemia in IBD are multifactorial, iron deficiency anemia (IDA) is the most common. Assessment of the iron status of patients who have a condition associated with inflammation, such as IBD, by using common biochemical values is insufficient. However, new indices of iron metabolism (for instance ferritin:transferrin receptor ratio, reticulocyte hemoglobin content or percentage of hypochromic red blood cells) may help to improve the assessment of iron status in patients with IBD. The treatment of IDA traditionally involves oral iron supplementation. However, because of extensive gastrointestinal adverse effects, and data showing that the use of oral iron in IBD may be associated with disease exacerbation, current guidelines suggest that iron supplementation in IBD should be administered intravenously. This Review provides an overview of iron homeostasis in health before discussing diagnostic and therapeutic strategies for IDA in patients with IBD.     

Management of Anemia in Patients with Inflammatory Bowel Disease (IBD)

Purpose of Review

Anemia is the most common complication as well as an extra intestinal manifestation of inflammatory bowel disease (IBD). It is associated with a significant impact on patient’s quality of life (QoL); as well it represents a common cause of frequent hospitalization, delay of hospital inpatient discharge and overall increased healthcare burden. In spite of all these, anemia is still often underdiagnosed and undertreated. Our aim in this review is to provide a pathway for physicians to help them achieve early diagnosis as well as timely and appropriate treatment of anemia which in turn would hopefully reduce the prevalence and subsequent complications of this condition among IBD patients.

Recent Findings

The etiology of anemia among IBD patients is most commonly due to iron deficiency anemia (IDA) followed by anemia of chronic disease. Despite this, more than a third of anemic ulcerative colitis (UC) patients are not tested for IDA and among those tested and diagnosed with IDA, a quarter are not treated with iron replacement therapy. A new algorithm has been validated to predict who will develop moderate to severe anemia at the time of UC diagnosis. While oral iron is effective for the treatment of mild iron deficiency-related anemia, the absorption of iron is influenced by chronic inflammatory states as a consequence of the presence of elevated levels of hepcidin. Also, it is important to recognize that ferritin is elevated in chronic inflammatory states and among patients with active IBD, ferritin levels less than 100 are considered to be diagnostic of iron deficiency. Newer formulations of intra-venous (IV) iron have a good safety profile and can be used for replenishment of iron stores and prevention of iron deficiency in the future.

Summary

Routine screening for anemia is important among patients with IBD. The cornerstone for the accurate management of anemia in IBD patients lies in accurately diagnosing the type of anemia. All IBD patients with IDA should be considered appropriate for therapy with iron supplementation whereas IV administration of iron is recommended in patients with clinically active IBD, or for patients who are previously intolerant to oral iron, with hemoglobin levels below 10 g/dL, and in patients who need erythropoiesis-stimulating agents (ESAs). As the recurrence of anemia is common after resolution, the monitoring for recurrent anemia is equally important during the course of therapy.

     

State of the iron: How to diagnose and efficiently treat iron deficiency anemia in inflammatory bowel disease

Iron deficiency anemia (IDA) frequently occurs in patients suffering from inflammatory bowel disease (IBD) and negatively impacts their quality of life. Nevertheless, the condition appears to be both under-diagnosed and undertreated. Regular biochemical screening of patients with IBD for anemia by the gastroenterology community has to be advocated.Oral iron is a low cost treatment however its effectiveness is limited by low bioavailability and poor tolerability. Intravenous (IV) iron rapidly replenishes iron stores and has demonstrated its safe use in a number of studies in various therapeutic areas. A broad spectrum of new IV iron formulations is now becoming available offering improved tolerability and patient convenience by rapidly restoring the depleted iron status of patients with IBD. The following article aims to review the magnitude of the problem of IDA in IBD, suggest screening standards and highlight existing and future therapies.     

Treatment of iron deficiency anemia associated with gastrointestinal tract diseases

The gastrointestinal (GI) tract is a common site of bleeding that may lead to iron deficiency anemia (IDA). Treatment of IDA depends on severity and acuity of patients’ signs and symptoms. While red blood cell transfusions may be required in hemodynamically unstable patients, transfusions should be avoided in chronically anemic patients due to their potential side effects and cost. Iron studies need to be performed after episodes of GI bleeding and stores need to be replenished before anemia develops. Oral ...     

Emerging causes of iron deficiency anemia refractory to oral iron supplementation

While oral iron supplementation is commonly used throughout many clinical setting,treatment with intravenous(IV) iron has historically been reserved for specific settings,such as chronic kidney disease,gynecologic issues,and anemia associated with cancer and its treatments.However,the use of IV iron has begun to gain popularity in the treatment of iron deficiency anemia(IDA) associated with two conditions that are being seen more frequently than in years past:patients who are status post gastric bypass procedure and those with inflammatory bowel disease(IBD).The Roux-en-Y procedure involves connecting a gastric pouch to the jejunum,creating a blind loop consisting of distal stomach,duodenum,and proximal jejunum that connects to the Roux limb to form a common tract.IDA occurs in 6%-50% of patients who have undergone a gastric bypass,the etiology being multifactorial.The proximal gastric pouch,the primary site of gastric acid secretion,is bypassed,resulting in a decreased ability to metabolize molecular iron.Once metabolized,most iron is absorbed in the duodenum,which is entirely bypassed.After undergoing bypass procedures,most patients significantly limit their intake of red meat,another factor contributing to post-bypass IDA.Chronic anemia occurs in approximately 1/3 of patients who suffer from IBD,and almost half of all IBD patients are iron deficient.IBD leads to IDA through multiple mechanisms,including chronic intestinal blood loss,decreased absorption capabilities of the duodenum secondary to inflammation,and an inability of many IBD patients to tolerate the side effects of oral ferrous sulfate.In this study,we reviewed the charts of all patients who received IV iron at Sylvester Comprehensive Cancer Center/University of Miami Hospital Clinic from January 2007 to May 2012.The most common indications for IV iron were for issues related to cancer and its treatment(21.9%),IBD(20.1%),and gastric bypass(15.0%).Of the 262 patients who received IV iron,230 received iron sucrose and 36 received iron dextran.While doses of 100,200,300,and 400 mg of iron sucrose were given,100 and 200 mg were by far the most common dosages used,122 and 120 times,respectively.The number of dosages of iron sucrose given ranged from 1 to 46,with a mean of 5.5 and a median of 4 doses.The average dose of iron dextran given was 870.5 mg,with 1000 mg being the most common dosage used.Most patients(22 of 36) who received iron dextran only received one dose.While patients with traditional indications for IV iron,such as gynecologic issues and kidney disease,still were represented in this study,we expect to see a continued increase in physicians using IV iron for emerging gastrointestinal indications,especially considering the increased safety of new low-molecular formulations.     

Treatment of iron deficiency anemia in pediatric inflammatory bowel disease

Opinion statement Anemia is a frequent extraintestinal manifestation of inflammatory bowel disease (IBD) that is commonly overlooked, despite its significant impact on quality of life. Characteristic symptoms include chronic fatigue, headache, and subtle impairment of cognitive function, although some less common symptoms include dyspnea, dizziness, pica, angular stomatitis, shortened attention span, and esophageal webs. Several types of anemia are associated with IBD, but iron deficiency anemia (IDA) accounts for the majority of cases and others include anemia of chronic disease, anemia associated with vitamin deficiency (vitamin B₁₂ and folate), autoimmune anemia, and anemia caused by medication used to treat IBD. The diagnosis of IDA relies on laboratory blood tests. Therefore, these tests should be obtained on a regular basis because characteristic symptoms may be absent or not readily recognized by patients and their clinicians. Complete blood count may suffice; however, iron studies and serum vitamin levels may be necessary to differentiate between specific types of anemia. During the diagnostic process, it is important to consider coexistence of different types of anemia, especially if no response to therapy is noted. The therapy for anemia is directed towards treatment of the underlying inflammatory process and supplemental therapy, depending on the type of deficiency. Iron deficiency anemia is treated with iron preparations, first orally, and if unresponsive or if associated with untoward adverse events leading to decrease in adherence with the therapeutic regimen, with intravenous preparations. Intramuscular therapy has been abandoned due to high rate of complications. Intravenous therapy may be administered as a multiple-dose regimen (intravenous iron sucrose and gluconate) or as a single intravenous dose (iron dextran), which is associated with a higher risk of allergic infusion reactions and requires obligatory test dose administration. Treatment with erythropoietin is reserved for a select subgroup of patients with anemia of chronic disease. With appropriate treatment, the majority of patients with IBD will have significant improvement or resolution of anemia, which can lead to a better quality of life. However, a high index of suspicion should be maintained in order to identify the precise cause of anemia and to prescribe the appropriate therapy.     

Intravenous iron sucrose versus oral iron supplementation for the treatment of iron deficiency anemia in patients with inflammatory bowel disease--a randomized, controlled, open-label, multicenter study

OBJECTIVES: Anemia is a frequent complication in patients with inflammatory bowel disease (IBD). The optimal route for iron supplementation to replenish iron stores has not been determined so far. We therefore evaluated the efficacy and safety of intravenous iron sucrose as compared with oral iron sulfate for the treatment of iron deficiency anemia (IDA) in patients with IBD. METHODS: A randomized, prospective, open-label, multicenter study was performed in 46 patients with anemia and transferrin saturation 相似文献   

Diagnosing anemia in inflammatory bowel disease: Beyond the established markers

The main types of anemia in inflammatory bowel disease (IBD) are iron deficiency anemia (IDA) and anemia of inflammatory etiology, or anemia of chronic disease (ACD). In the management of IBD patients with anemia it is essential for the physician to diagnose the type of anemia in order to decide in an evidence-based manner for the appropriate treatment. However, the assessment of iron status in IBD in many cases is rather difficult due to coexistent inflammation. For this assessment several indices and markers have been suggested. Ferritin, seems to play a central role in the definition and diagnosis of anemia in IBD and transferrin, transferrin saturation (Tsat), and soluble transferrin receptors are also valuable markers. All these biochemical markers have several limitations because they are not consistently reliable indices, since they are influenced by factors other than changes in iron balance. In this review, in addition to them, we discuss the newer alternative markers for iron status that may be useful when serum ferritin and Tsat are not sufficient. The iron metabolism regulators, hepcidin and prohepcidin, are still under investigation in IBD. Erythrocytes parameters like the red cell distribution width (RDW) and the percentage of hypochromic red cells as well as reticulocyte parameters such as hemoglobin concentration of reticulocytes, red blood cell size factor and reticulocyte distribution width could be useful markers for the evaluation of anemia in IBD.