Prevalence and outcome of anemia after restorative proctocolectomy: A clinical literature review

Amosy E. M'Koma, Paul E. Wise, David A. Schwartz, Roberta L. Muldoon, Alan J. Herline

Research output: Contribution to journalReview article

17 Citations (Scopus)

Abstract

PURPOSE: Iron and/or vitamin B12 deficiency anemias, which have adverse effects on patients' quality of life, are commonly observed and often overlooked complications after restorative proctocolectomy. We performed a systematic review of publications on the prevalence of anemia as well as on the impact of anemia on a range of clinical, functional, quality of life, and economic outcomes in restorative proctocolectomy patients. This information is important to help healthcare providers through a comprehensive overview to increase awareness about a condition that could require therapy to improve patient healthcare and quality of life. METHODS: We reviewed the English language publications on the incidence of anemia and its adverse effect after restorative proctocolectomy The United States National Library of Medicine database (MEDLINE), the Excerpta Medica database (EMBASE), the Cochran Library, and the GoogleA search engine were searched for published articles on the prevalence and impact of anemia in post-restorative proctocolectomy surgical patients. RESULTS: The long-term complication most frequently described after RPC is pouchitis. Pouchitis is significantly associated with iron deficiency anemia caused by pouch mucosal bleeding. Other causes are insufficient and/or impaired iron absorption. It has also been observed, however, that restorative proctocolectomy patients with underlying familial adenomatous polyposis rarely develop pouchitis yet show higher rates of iron deficiency anemia compared to those patients with underlying ulcerative colitis. Other causes shown as independent risk factors for iron deficiency anemia in restorative proctocolectomy patients are malignancy, desmoid tumors, and J-pouch configuration. Vitamin B12 deficiency anemia is also common after restorative proctocolectomy. About one-third of restorative proctocolectomy patients show abnormal Schilling test and 5 percent have low referenced serum cobalamin. It has been observed that the degree resection of the terminal-ileum, malabsorption, bacterial overgrowth, and dietary factors are among the known causes of cobalamin deficiency. Folate deficiency has not been reported in restorative proctocolectomy patients. Describing restorative proctocolectomy surgery and its outcomes, in patients without anemia, the quality of life is reported excellent regardless of operative technique. CONCLUSIONS: Anemia is not uncommon following restorative proctocolectomy and has been shown to have negative effects on the patient's quality of life and the economy and may substantially increase healthcare costs. The treatment of anemia and its underlying causes is important to improving clinical and economic outcomes.

Original languageEnglish (US)
Pages (from-to)726-739
Number of pages14
JournalDiseases of the Colon and Rectum
Volume52
Issue number4
DOIs
StatePublished - Apr 1 2009

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Restorative Proctocolectomy
Anemia
Pouchitis
Quality of Life
Iron-Deficiency Anemias
Vitamin B 12 Deficiency
Vitamin B 12
Publications
Schilling Test
Iron
Economics
Databases
National Library of Medicine (U.S.)
Aggressive Fibromatosis
Colonic Pouches
Search Engine
Adenomatous Polyposis Coli
Ulcerative Colitis
Ileum
Folic Acid

Keywords

  • Anemia
  • Desmoids tumors
  • Economic outcomes
  • Familial adenomatous polyposis
  • Patient's quality of life
  • Restorative proctocolectomy
  • Ulcerative colitis

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Prevalence and outcome of anemia after restorative proctocolectomy : A clinical literature review. / M'Koma, Amosy E.; Wise, Paul E.; Schwartz, David A.; Muldoon, Roberta L.; Herline, Alan J.

In: Diseases of the Colon and Rectum, Vol. 52, No. 4, 01.04.2009, p. 726-739.

Research output: Contribution to journalReview article

M'Koma, Amosy E. ; Wise, Paul E. ; Schwartz, David A. ; Muldoon, Roberta L. ; Herline, Alan J. / Prevalence and outcome of anemia after restorative proctocolectomy : A clinical literature review. In: Diseases of the Colon and Rectum. 2009 ; Vol. 52, No. 4. pp. 726-739.
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T2 - A clinical literature review

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AU - Wise, Paul E.

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AU - Muldoon, Roberta L.

AU - Herline, Alan J.

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N2 - PURPOSE: Iron and/or vitamin B12 deficiency anemias, which have adverse effects on patients' quality of life, are commonly observed and often overlooked complications after restorative proctocolectomy. We performed a systematic review of publications on the prevalence of anemia as well as on the impact of anemia on a range of clinical, functional, quality of life, and economic outcomes in restorative proctocolectomy patients. This information is important to help healthcare providers through a comprehensive overview to increase awareness about a condition that could require therapy to improve patient healthcare and quality of life. METHODS: We reviewed the English language publications on the incidence of anemia and its adverse effect after restorative proctocolectomy The United States National Library of Medicine database (MEDLINE), the Excerpta Medica database (EMBASE), the Cochran Library, and the GoogleA search engine were searched for published articles on the prevalence and impact of anemia in post-restorative proctocolectomy surgical patients. RESULTS: The long-term complication most frequently described after RPC is pouchitis. Pouchitis is significantly associated with iron deficiency anemia caused by pouch mucosal bleeding. Other causes are insufficient and/or impaired iron absorption. It has also been observed, however, that restorative proctocolectomy patients with underlying familial adenomatous polyposis rarely develop pouchitis yet show higher rates of iron deficiency anemia compared to those patients with underlying ulcerative colitis. Other causes shown as independent risk factors for iron deficiency anemia in restorative proctocolectomy patients are malignancy, desmoid tumors, and J-pouch configuration. Vitamin B12 deficiency anemia is also common after restorative proctocolectomy. About one-third of restorative proctocolectomy patients show abnormal Schilling test and 5 percent have low referenced serum cobalamin. It has been observed that the degree resection of the terminal-ileum, malabsorption, bacterial overgrowth, and dietary factors are among the known causes of cobalamin deficiency. Folate deficiency has not been reported in restorative proctocolectomy patients. Describing restorative proctocolectomy surgery and its outcomes, in patients without anemia, the quality of life is reported excellent regardless of operative technique. CONCLUSIONS: Anemia is not uncommon following restorative proctocolectomy and has been shown to have negative effects on the patient's quality of life and the economy and may substantially increase healthcare costs. The treatment of anemia and its underlying causes is important to improving clinical and economic outcomes.

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KW - Desmoids tumors

KW - Economic outcomes

KW - Familial adenomatous polyposis

KW - Patient's quality of life

KW - Restorative proctocolectomy

KW - Ulcerative colitis

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