Vitamin D Therapy in Inflammatory Bowel Diseases who, in what form, and how much?
Journal of Crohn's and Colitis DOI: http://dx.doi.org/10.1093/ecco-jcc/jju004 First published online: 26 November 2014
Tibor Hlavaty, Anna Krajcovicova, Juraj Payer
Background: The north–south geographical gradient of inflammatory bowel disease (IBD) prevalence, the epidemiology of IBD and its genetic association with vitamin D receptor polymorphisms, and results in animal models suggest that vitamin D plays an important role in the pathogenesis of IBD.
Aims: The purpose of this review was to critically appraise the effectiveness and safety of vitamin D therapy in patients with IBD.
Methods: MEDLINE, Scopus and Google Scholar were searched from inception to 20th May 2014 using the terms ‘Crohn’s disease’, ‘ulcerative colitis’ and ‘vitamin D’.
Results: Vitamin D deficiency is common in patients with IBD. Limited clinical data suggest an association between low vitamin D concentration and increased disease activity in both ulcerative colitis (UC) and Crohn’s disease (CD). To date, only two small open label trials and one randomised controlled trial have shown a positive effect of vitamin D supplementation on disease activity in patients with CD but not UC.
An optimal vitamin D supplementation protocol for patients with IBD remains undetermined, but targeting serum 25(OH)D levels between 30 and 50 ng/ml appears safe and may have benefits for IBD disease activity. Depending on the baseline vitamin D serum concentration, ileal involvement in CD, body mass index and, perhaps, smoking status, daily vitamin D doses between 1800–10,000 IU/day are probably necessary.
Conclusion: Increasing pre-clinical and clinical evidence suggests a role for vitamin D deficiency in the development and severity of IBD. The possible therapeutic role of vitamin D in patients with IBD merits continued investigation.
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