Trend Indicated Between Anemia and Childhood Inflammatory Bowel Disease

A recent retrospective observational, nationwide register-based multicenter cohort study conducted in Italy revealed a trend of anemia in children with inflammatory bowel disease (IBD).1

Various studies have concluded that large percentages of children diagnosed with IBD worldwide simultaneously suffer from various forms of anemia. Relatively little research, however, has been conducted into the efficacy and success of the various methods of treatment, such as iron therapy.2

"Anemia is one of the most common extraintestinal manifestations in children with IBD, therefore fully understanding and characterizing it in this population is critical," wrote Giulia D’Arcangelo, maternal and child health department, Sapienza University of Rome, and colleagues. “To the best of our knowledge, our study reports the largest cohort of anemic children with IBD at the diagnosis published so far.”1

Investigators initially collected data from 2780 patients enrolled in the Italian Society of Gastroenterology, Hepatology, and Nutrition IBD registry. All participants were <18 years of age and newly diagnosed with IBD and anemia. Patients with inadequate lab data to determine diagnosis were excluded, leaving 1634 participants. A total of 748 were diagnosed with Crohn’s disease (CD) and 886 with ulcerative colitis (UC).1

Notably, 589 participants were diagnosed with anemia, with 295 also having CD and 294 UC. D’Arcangelo and colleagues discovered a much higher prevalence of anemia in participants with UC than those with CD (39% vs 33%, P =.009).1

Most of the participants presented with moderate (55%) and microcytic anemia (81%), while iron deficiency anemia (IDA) was diagnosed in 471 out of 537 (87.7%) children. Participants with UC showed a higher frequency of IDA than those with CD.1

Upon analysis, a lower age at diagnosis and lower albumin level directly correlated with anemia severity (P =.0007 and <.0001 respectively) in children with CD, while severe disease was more common in patients with severe anemia than mild or moderate (20.6% vs 43.6%, P =.01; 17% vs 43.6%, P =.001) in those with UC.1

D'Arcangelo and colleagues collected participant data at anemia diagnosis and 1 year afterwards. At the point of follow-up one year later, 158 children did not have sufficient lab data for the definition of anemia and were removed from subsequent study. Among the remaining participants, D’Arcangelo and colleagues noted that 46 out of 222 (20.7%) with CD and 53 out of 209 (25.3%) with UC were anemic a year later.1

The follow-up period came after IBD treatment for the participants, of which 22.9% still displayed anemia despite the treatment. These participants showed signs of more severe disease, evidenced by higher pediatric ulcerative colitis activity index (PUCAI) scores in UC and higher weighted Pediatric Crohn's disease activity index (wPCDAI) levels in CD. The data gathered at follow-up indicates a persistence rate of 17-20%, which is likely to stabilize over the following 10 years.1

Investigators stated that, in total, more than 1/3 of children with IBD present most commonly with moderate anemia. Children with CD had higher rates of mild anemia (38% vs 33%, P <.0001), and severe anemia was more common in children with UC (13% vs 6%, P =.001). Additionally, 1 in 4 patients was still anemic a full year after initial diagnosis.1

The team also points out that, despite recent improvements in therapeutic options for children with IBD, there has been no significant impact on prevalence of anemia. D’Arcangelo and colleagues indicate that a comprehensive analysis of specific treatments and their impact on anemia was outside the scope of the study, but believe that the results described here encourage further investigation of the efficacy of various treatments.1

“Despite recommendations and increased awareness raised by organizations such as the European Crohn’s and Colitis Organization (ECCO), there remains insufficient attention to and therapeutic management of this issue,” wrote D’Arcangelo and colleagues. “This is particularly critical in children, as unrecognized and untreated iron deficiency can significantly impact their development and cognitive performance.”1

References

1. D'Arcangelo G, Brecciaroli M, Gagliostro G, et al. Prevalence and trend of anemia in children with inflammatory bowel disease: A national register-based cohort study. J Pediatr Gastroenterol Nutr. 2025; 1-12. doi:10.1002/jpn3.70029

2. D'Arcangelo G, Distante M, Veraldi S, Tarani F, Musto F, Aloi M. Natural History of Anemia and Efficacy and Safety of Oral Iron Therapy in Children Newly Diagnosed With Inflammatory Bowel Disease. J Pediatr Gastroenterol Nutr. 2023;76(6):771-775. doi:10.1097/MPG.0000000000003764