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Ulcerative Colitis relapse 25 percent more likely if vitamin D level is lower than 35 ng – June 2016

Low Serum Vitamin D During Remission Increases Risk of Clinical Relapse in Patients with Ulcerative Colitis.

Clin Gastroenterol Hepatol. 2016 Jun 3. pii: S1542-3565(16)30270-1. doi: 10.1016/j.cgh.2016.05.035. [Epub ahead of print]
Gubatan J1, Mitsuhashi S2, Zenlea T2, Rosenberg L2, Robson S2, Moss AC2.
1Department of Medicine, Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA. Electronic address: jgubatan at bidmc.harvard.edu.
2Department of Medicine, Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.

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BACKGROUND & AIMS:
Vitamin D levels have been associated with disease activity in patients with ulcerative colitis (UC), but it is unclear whether they affect the risk of disease relapse. We sought to determine the association between baseline vitamin D levels during a period of clinical remission and risk of subsequent UC relapse.

METHODS:
We performed a physician-blinded prospective study of 70 patients with UC in clinical remission followed after a surveillance colonoscopy at a tertiary academic medical center. Serum samples were collected at the time of colonoscopy and baseline endoscopic and histologic activity were determined. Levels of 25-hydroxy-vitamin D were measured using an ELISA. The primary outcome was rate of clinical relapse, determined over 12 months.

RESULTS:
The mean baseline vitamin D level was lower among patients with relapse (29.5 ng/mL) than without (50.3 ng/mL) (P=.001). Remission vitamin D level (= 35 ng/mL) was associated with risk of clinical relapse (odds ratio OR, 1.25; 95% confidence interval CI, 1.01-1.56; P=.044) over 12 months, independent of endoscopic or histologic grade at enrollment. A receiver operating characteristic curve of vitamin D levels for the outcome of relapse had an area under the curve of 0.72; a serum level = 35 ng/mL had a sensitivity of 70% (95% CI 46%-88%) and specificity of 74% (95% CI 57%-83%) for predicting risk of clinical relapse.

CONCLUSIONS:
Serum levels of vitamin D = 35 ng/mL during periods of clinical remission increase the risk of UC relapse. Clinical trials to obtain vitamin D levels above this threshold should be considered.

Copyright © 2016 AGA Institute. Published by Elsevier Inc. All rights reserved.

PMID: 27266980 DOI: 10.1016/j.cgh.2016.05.035

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