Vitamin D Deficiency Is Associated with Endoscopic Severity in Patients with Crohn’s Disease

Abstract

Background and Aims Vitamin D deficiency is common in patients with Crohn's disease and is associated with disease activity. Relationship between vitamin D and endoscopic disease activity is unknown. The aim of the study is to determine the association between vitamin D status and endoscopic disease activity in CD patients. Methods Consecutive hospitalized CD patients from 2014 to 2016 who received vitamin D assessment and colonoscopy were retrospectively evaluated. Clinical disease activity was assessed by Crohn's disease activity index and C-reactive protein. Endoscopic activity was calculated using simple endoscopic score for Crohn's disease. Results Median serum 25OHD level of 131 patients was lower than healthy controls [21.1 nmol/L (11.8–32.3) versus 49.9 nmol/L (44.9–57.4), P = 0.007]. 125 (95%) patients had vitamin D deficiency and the rest (5%) had vitamin D insufficiency. Serum 25OHD was inversely correlated with CRP (r = −0.308, P < 0.001), CDAI (r = −0.582, P < 0.001), SES-CD (r = −0.294, P = 0.001), and endoscopic severity stratified by SES-CD (P = 0.001). Conclusion Vitamin D deficiency was prevalent among hospitalized CD patients. Vitamin D levels were inversely correlated with endoscopic disease activity. Vitamin D status could be a biomarker in assessing disease activity among hospitalized CD patients in addition to CDAI and CRP.

Systematic review with meta‐analysis: association of vitamin D status with clinical outcomes in adult patients with inflammatory bowel disease

“…Out of 1351 citations, 27 articles comprising of 8316 IBD patients met our predefined inclusion and exclusion criteria. The PRISMA flow diagram is presented in Figure .…”

“…Figure shows the forest plot of low 25(OH)D status and risk of clinically active disease. For the outcome of clinically active disease, 17 studies met inclusion criteria and included a total of 3143 patients. There was no evidence of publication bias based on funnel plot asymmetry (Figure S1A, Egger's Test P = .768).…”

“…For the outcome of mucosal inflammation, nine studies met inclusion criteria and included a total of 1089 patients . Assessment for publication bias was not performed given less than 10 included studies.…”

“…Low vitamin D status was defined by vitamin D deficiency thresholds set by individuals studies. Most of our included studies defined low 25(OH)D with a serum level < 20 ng/mL (19 studies). Five studies defined low 25(OH)D as <30 ng/mL.…”

“…The same study demonstrated that IBD patients also had increased odds of lower vitamin D levels compared to matched controls. Due to the potential mechanistic link between vitamin D and colitis and the high prevalence of vitamin D deficiency in IBD patients, many groups have sought to examine the impact of vitamin D levels on IBD clinical outcomes, often with conflicting results. Many of these previous studies were limited by their small sample size and inability to detect differences in clinical outcomes between low and high vitamin D groups.…”