P155. Vitamin D status in inflammatory bowel disease: Are clinicians seeing the light?
R.O. Butcher1, L.E. Loo1, E. Nixon1, X. McFarlane1, J.K. Limdi1
1Pennine Acute Hospitals NHS Trust, Gastroenterology, Manchester, United Kingdom
Background: There has been resurgent interest in recent years in the pro-hormone vitamin D beyond its classical role in bone metabolism recognizing its plausible effects in immune regulation. The aim of our study was to review practice relating to vitamin D assessment amongst IBD patients.
Methods: We conducted a retrospective review of 280 consecutive patients attending IBD clinics at our hospital. Clinical data including demographics, disease characteristics and therapy were obtained from case note and electronic patient record review. Measurement of serum 25-hydroxyvitamin D (25-OHD) concentration subsequent to IBD diagnosis was noted.
Results: Of 280 IBD patients reviewed, 128 were female. The median age was 47.5 (Range 1691) and mean disease duration 9.7 years. One hundred and twenty nine patients had Crohn's disease, 142 patients ulcerative colitis and 9 patients had an indeterminate colitis. Thirty-nine patients (13.9%) were current smokers and 77 patients (27.5%) ex-smokers.
Vitamin D status was assessed in 33 (11.8%) patients. In 29 patients (87.9%) measurement was undertaken within the last 2 years. The mean and median serum 25-OHD level was 16.9 and 15.7 ng/mL respectively (range 544.4). Eight (24.2%) of these patients had levels <10 ng/mL consistent with deficiency and 14 (42. 4%) levels <20 ng/mL. Of the 8 patients with vitamin D deficiency (3 males; 5 females), six had Crohn's disease and two had ulcerative colitis. Of the Crohn's patients, 3 had ileo-colonic, 2 colonic and 1 ileal disease. Three had non-stricturing and non-penetrating disease, 2 stricturing and 1 penetrating disease. Of the ulcerative colitis patients 1 had extensive and 1 distal disease. All patients had received steroids during the course of their disease and 3 patients received azathioprine, 4 anti‑TNF (3 infliximab; 1 adalimumab) and 4 had previous surgery. Patients with vitamin D deficiency had significant disease requiring immunomodulator, anti‑TNF therapy and surgery in this cohort.
Conclusions: Vitamin D assessment in IBD patients is suboptimal. Hypovitaminosis D is under-recognized and consequently undertreated. The myriad emerging roles of vitamin D in the pathogenesis of IBD emphasize the importance of recognition and optimization of vitamin D status to above 30 ng/mL in this patient group.