Persistent or Recurrent Anemia Is Associated With Severe and Disabling Inflammatory Bowel Disease

Ioannis E. Koutroubakis, Claudia Ramos-Rivers, Miguel Regueiro, Efstratios Koutroumpakis, Benjamin Click, Robert E. Schoen, Jana G. Hashash, Marc Schwartz, Jason Swoger, Leonard Baidoo, Arthur Barrie, Michael A. Dunn, David G. Binion*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

48 Scopus citations


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.

Original languageEnglish (US)
Article number54359
Pages (from-to)1760-1766
Number of pages7
JournalClinical Gastroenterology and Hepatology
Issue number10
StatePublished - Oct 1 2015


  • C-Reactive Protein
  • Crohn's Disease
  • Erythrocyte Sedimentation Rate
  • Quality of Life
  • Ulcerative Colitis

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology


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