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Crohn’s Disease – strange things such as no change of vitamin D levels with season – Dec 2014

Vitamin D deficiency is Associated With Disease Duration and Phenotype But Not Activity in Patients With Crohn's Disease.

P-057 YI, Clinical Poster Presentations:
Inflammatory Bowel Diseases:, December 2014 - Volume 20
doi: 10.1097/01.MIB.0000456794.47584.cc
Seyed, Jalali

BACKGROUND: Crohn's disease (CD) is a chronic inflammatory disorder associated with vitamin D deficiency, which is potentially due to decreased oral intake and reduced absorption. We aim to identify which CD patients are prone to vitamin D insufficiency and deficiency.

METHODS: This is a retrospective chart review of 608 consecutive clinical encounters of adult patient swith confirmed CD seen in our clinic from July 2011 to June 2013, Age, sex, race, Montreal classification, duration of disease, Harvey Bradshaw Index (HBI), Short Inflammatory Bowel Disease Questionnaire (SIBDQ) scores, erythrocyte Sedimentation rate (ESR), C-reactive protein (CRP) levels, physician global assessment, endoscopic appearance, histologic activity, medication use, and body mass index (BMI) were collected from each clinical encounter associated with drawing a serum 25-Hydroxy Vitamin D level (VDL). Vitamin D deficiency (VDD) was defined as VDL<20 ng/mL, and vitamin D insufficiency (VDI) was defined as 20 ng/mL < VDL < 30 ng/mL. One-way ANOVA, Chi-square test and Logistic Regression were used to analyze the data.

RESULTS: Three hundred nine clinical encounters were associated with drawing a VDL in 200 patients with Crohn's disease. The mean age was 43.4 +/- 14.9 years; 70.3% were Caucasian, and 51.7% were male. The mean duration of disease was 11.0 +/- 10.6 years. 31.3% of patients had normal VDL, 37.3% had VDI, and 31.3% had VDD.

  • There was no seasonal variation of VDL (P = 0.118).
  • Patients with VDD were more likely to have ileocolonic disease than isolated ileal disease or isolated colonic disease (51.1% versus 38.6% or 10.6%, P = 0.018).
  • Patients with fibrostenotic or penetrating disease were more likely to have VDD (45.0% or 35.1% versus 17.9%, P = 0.000).
  • There was no association between 25-OHD and perianal (P = 0.251) or proximal (P = 656) disease.
  • Patients on biologic therapy were more likely to have VDD or VDI than those that were not on biologic therapy (34.3% versus 27.6% and 40.4% versus 33.6%, respectively, P = 0.043).
  • Similarly, patients being treated with 5-ASA medications were less likely to have VDD (33.5% versus 22.4%, P = 0.008).
  • Low VDL correlated with longer duration of disease (P = 0.030).
  • There was no association between VDL and disease activity nor with BMI.

CONCLUSIONS: The majority of our patients had low VDL unrelated to race or season despite being in a region that experiences significant changes. Our data demonstrates that disease location, behavior and duration all paly a role in vitamin D metabolism and absorption in CD patients. Patients requiring more immunosuppression were more likely to have low VDL. This suggests that long term factors in disease severity, rather than short-lived states of disease activity, have a significant impact on VDL.

(C) Crohn's & Colitis Foundation of America, Inc.

See also VitaminDWiki