Abstract
The main role of vitamin D is calcium homeostasis and bone metabolism, although its activity as an immuno-modulator and its anti-inflammatory effect is well-known. Low blood vitamin D levels are common among patients with inflammatory bowel disease (IBD). Whether low vitamin D levels could affect the disease activity or it is an effect of a worse condition of the disease is still unclear. This study aimed to investigate the role of blood vitamin D levels to identify the clinical, endoscopic, and histological activity in a cohort of patients with ulcerative colitis (UC) or Crohn’s disease (CD) on therapy with biological drugs. In this retrospective cohort study, 50 IBD patients (24 UC and 26 CD) that underwent colonoscopy from January 2017 to January 2020 with a concomitant serological evaluation of vitamin D were included. Patients with clinical, endoscopic, and histological activity and those who lost their clinical response to the biological drug had lower vitamin D levels compared to patients in remission or patients that did not change therapeutic regimens. A receiver operating characteristic (ROC) analysis and Youden’s Index were performed to assess the optimal vitamin D levels to identify patients with the active disease. The ROC analysis showed an area under the curve (AUC) of 0.709 (p = 0.005; confidence interval (CI): 0.564–0.829), 0.769 (p < 0.001; CI: 0.628–0.876), and 0.810 (p < 0.001; CI: 0.670–0.910) for the clinical, endoscopic, and histological outcomes, respectively. The optimal vitamin D cut-off was ≤25 ng/mL. The vitamin D level is an additional useful tool in the evaluation of IBD patients with good accuracy to predict their endoscopic and histological activity and clinical response to biologics.
Highlights
Inflammatory bowel diseases (IBD), which include ulcerative colitis (UC) and Crohn’s disease (CD), are chronic relapsing diseases [1,2]
Among IBD patients, whether low vitamin D levels could affect the disease activity or if it is a secondary effect of a worse condition of the disease is still unclear [13]
Fifty IBD patients in biological therapy (24 UC and 26 CD) who underwent a colonoscopy from January 2017 to January 2020 in our unit, with a concomitant serological evaluation of vitamin D, were included in our analysis
Summary
Inflammatory bowel diseases (IBD), which include ulcerative colitis (UC) and Crohn’s disease (CD), are chronic relapsing diseases [1,2]. The main role of vitamin D is calcium homeostasis and bone metabolism, several potential actions have been suggested in the last two decades [7]. Vitamin D deficiency has been reported in several chronic diseases associated with increased inflammation and deregulation of the immune system, including IBD [8,9]. It is important to underline that the prevalence of osteopenia or osteoporosis is higher among IBD patients on corticosteroid therapy [11], among these patients, low vitamin D levels and bone disease were observed independently of glucocorticoid administration [10]. A systematic review including 14 observational studies assessed the prevalence of vitamin D deficiency
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