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P090. Prospective controlled analysis of vitamin B12 and folate deficiency in Crohn's disease

F. Bermejo1, A. Algaba1, J.P. Gisbert2, I. Guerra1, A. Rodríguez2, G. Poza1, M. Chaparro2, P. Valer1, B. Piqueras1, J.C. Villa1, A. Bermejo1, J.L. Rodríguez-Agulló1

1Fuenlabrada University Hospital, Fuenlabrada, Spain; 2La Princesa University Hospital, Madrid, Spain

Aims: Crohn's Disease (CD) commonly involves small bowel, which is the site of vitamin B12 and folic acid absorption. Our aim was to prospectively define the incidence of B12 and folate deficiency in patients with CD and to identify predictive factors associated with such abnormalities.

Methods: Twenty-month prospective study of 180 patients with CD from two hospitals. Deficiency of B12 and folate was defined as levels <200 pg/ml and <4 ng/ml, respectively, with basal values within normal ranges in the previous 12 months. We analyzed several possible predictive factors: small bowel resection, CD location, disease activity (Harvey-Bradshaw index), duration of CD, gender, age, and smoking. Controls were patients with a diagnosis of ulcerative colitis evaluated at our hospitals (n = 70). Patients were excluded if they were previously receiving supplemental B12 and/or folate or they had a known cause of vitamin deficiency other than CD.

Results: Mean age was 40±13 years, 53% female, 34% smokers. The cumulative incidence of B12 deficiency in patients with CD was 15% (95% CI 9.7–20%) compared with 2.8% (95% CI 0.8–9.8%) in control group (p = 0.007). The incidence rate of B12 deficiency in patient with CD was 9% per patient-year. With regard to folate deficiency, the cumulative incidence in patients with CD was 22% (95% CI 16–28%) compared with 4.3% (95% CI 1.4–12%) in control group (p = 0.001). The incidence rate of folate deficiency in patient with CD was 13.2% per patient-year. Twenty-three percent of patients with B12 and/or folate deficiency had macrocytic anaemia (95% CI 14–35%). On univariate and multivariate analyses, only ileal resection was found to be a risk factor for B12 deficiency (OR 2.5; 95% CI 1.1–6.2; p = 0.04), and only CD activity was found to be a risk factor for folate deficiency (OR 2.4; 95% CI 1.1–5.1; p = 0.02).

Conclusion: A significant proportion of patients with CD suffer from vitamin B12 and/or folate deficiency (and associated anaemia), suggesting that monitoring of these vitamins in regular blood tests should be performed in CD patients. Patients with higher risk of vitamin B12 deficiency are those with ileal resection and patients with higher risk of folate deficiency are those with active CD.