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P034. Serum concentration of estrogen is associated with inflammatory bowel disease activity

P.M. Linares1, M. Chaparro1, A. Algaba2, J.P. Gisbert1, M. Guijarro Rojas3, F. Bermejo2, A.C. Urzainqui-Mayayo4, M.E. Fernández-Contreras1, 1Hospital Universitario de la Princesa-IP, Gastroenterology and CIBEREHD, Madrid, Spain, 2Hospital Universitario de Fuenlabrada, Gastroenterology, Fuenlabrada, Spain, 3Hospital Universitario de la Princesa-IP, Pathology, Madrid, Spain, 4Hospital Universitario de la Princesa-IP, Immunology, Madrid, Spain

Background

Recent studies suggest that gender might affect the clinical evolution of IBD. The anti-inflammatory properties of estrogens have been proposed to explain such differences. Our aim was to determine the possible association between levels of circulating estrogens and IBD activity.

Methods

Patients with IBD and non-IBD healthy volunteers were studied. Serum levels of the estrogen 17β-estradiol were measured by ELISA. Disease activity was assessed by the Mayo score, for ulcerative colitis (UC) and by the Harvey–Bradshaw index, for Crohn's disease (CD). All subjects were younger than 45 years. Controls with history of allergy or autoimmune disorders were excluded.

Results

132 samples from 110 patients with IBD (60 CD and 50 UC) and 20 controls (15 females and 5 males) were analyzed. 50% of patients were males, and 23% of samples corresponded to active IBD. Serum estrogen concentrations did not differ significantly between patients and controls. Higher levels tended to be associated with inactive disease (P = 0.08), this association being stronger in males (P = 0.06; Table 1).

Estrogen levels were inversely related with the grade of disease activity (data not shown), with differences between inactive and moderate-severe disease among men (34.1±5.0 vs 30.0±1.4; P = 0.03). By type of IBD (Table 2), patients with CD tended to show higher levels of estrogen than those with UC (P = 0.08), this trend being stronger in women with inactive disease (P = 0.06). In contrast, the highest values of estrogen concentration in men were clearly associated with UC (P = 0.03).

Table 1
 Inactive*Active*P-value
Total56.9±51.638.6±13.40.08
CD65.3±63.941.7±16.10.2
UC47.1±3034.3±7.10.2
Female78.6±65.248.3±15.80.1
Male34.1±4.931.4±3.70.06
*Mean ng/ml ±SD; SD: Standard deviation.
Table 2
  CD*UC*P-value
All patientsTotal59.5±56.844.3±27.30.08
 Inactive65.34±63.947.1±30.00.1
 Active41.±16.134.3±7.10.2
FemalesTotal84.4±70.056.0±37.30.08
 Inactive95.4±77.458.3±39.50.06
 Active51.±17.140.5±9.40.3
MalesTotal32.1±3.534.8±5.60.03
 Inactive32.5±3.935.9±5.50.03
 Active30.8±1.332.0±5.00.6
*Mean ng/ml ±SD; SD: Standard deviation.

Conclusion

Serum estrogen is not related with the presence of IBD, but low levels are associated with disease activity. Serum concentration of estrogen was higher in male patients with UC than in those with CD, but the opposite trend was observed in females. This apparent gender-dependent link between serum estrogen and type of IBD may suggest a different role of this hormone in CD and UC.