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P549 Vitamin D deficiency as a part of extraintestinal manifestations in IBD Patients: a single-centre experience

A. Georgieva*1, A. Atanassova1, D. Gerova2, M. Todorova2

1Medical University Varna, Clinic of Hepatogastroenterology, St. Marina University Hospital, Vаrna, Bulgaria, 2Medical University Varna, Department of General Medicine and Clinical Laboratory, Varna, Bulgaria

Background

Vitamin D deficiency is more common in inflammatory bowel disease (IBD) patients than it is in the general population. The aim of this study was to evaluate the vitamin D serum levels in IBD patients as a part of the extraintestinal manifestations (EIMs) and to correlate the prevalence of hypovitaminosis D with existence of other EIMs.

Methods

The Vitamin D (25 OH D) status was measured in 94 IBD patients, 54 with CD and 40 with UC. 25(OH) D serum concentrations were measured by a commercial paramagnetic particle chemiluminescent immunoassay for the quantitative determination of total 25-hydroxyvitamin D [25(OH) vitamin D] levels. Vitamin D deficiency is defined as a serum level of 25OHD <50 nmol/l, and a serum level ˃50 nmol/l <75 nmol/l is classified as vitamin D insufficiency. The clinical course and the occurrence of EIMs were monitored. All Patients were classified according to the Montreal classification. CD activity was assessed using the BEST index (CDAI - Crohn Disease Activity Index) and the partial Mayo score was used to determine UC activity.

Results

Across all patients the mean serum 25(OH) D level was 44.47 ± 18.14 (nmol/l). Almost 95% of IBD patients have Vitamin D insufficiency and deficiency, respectively CD- 96.29% (n = 52), UC 92.50% (n = 37), as Vitamin D serum levels ˂ 50 nmol/l were detected in 61 (64.89%) of IBD patients - 66.66%( n = 36) for CD and 62.50% (n = 25) for UC. There was no significant difference between mean 25(OH) D levels in both diseases (p = 0.604). In 89% (n = 84) of IBD patients there was a presence of EIMs, in 96.42% (n = 81) of these patients there were low Vitamin D serum concentrations, respectively, CD 59.25% (n = 48) and UC 40.74% (n = 33). In IBD patients with EIMs the mean 25(OH) D levels were significantly lower (42.67 ± 17.29 vs. 59.58 ± 18.94) (р = 0.005). We found a significant difference between measured mean 25(OH) D concentrations in UC patients and EIMs presence (43.02 ± 17.38 vs. 63.70 ± 18.48) (р= 0.018), while in CD patients there is not a significant difference (р=0.122). The most common EIMs among our IBD patients are: iron deficiency without anaemia - 39.40% (n = 37), liver steatosis – 38.30% (n = 36), IBD associated arthropathy (IBDAA) - 33% (n = 31), followed by: Vitamin B 12 deficiency without anaemia, latent iron deficiency, ocular manifestations and primary sclerosing cholangitis (PSC). All IBD Patients with Iron and Vitamin B12 deficiency anaemia, latent Vitаmin B12 deficiency and malabsorption syndrome have low 25(OH) D serum levels.

Conclusion

Over 96% of patients with the EIMs also have a low Vitamin D serum levels. This correlation leads to the need for systematic monitoring of 25-hydroxyvitamin D levels during the course, follow-up and treatment of IBD