Inflammatory bowel diseases are helped by vitamin D – commissioned review Nov 2013

Review article: vitamin D and inflammatory bowel diseases

Alimentary Pharmacology & Therapeutics Article first published online: 17 NOV 2013. DOI: 10.1111/apt.12553
V. P. Mouli 1,
A. N. Ananthakrishnan 2,3,*
1 Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
2 Harvard Medical School, Boston, MA, USA
3 Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA
* Correspondence to: Dr A. N. Ananthakrishnan, Crohn's & Colitis Centre, Massachusetts General Hospital, 165 Cambridge Street, 9th Floor, Boston, MA 02114, USA. aananthakrishnan@partners.org
This commissioned review article was subject to full peer review and the authors received an honorarium from Wiley on behalf of AP&T.

Background: Vitamin D is traditionally associated with bone metabolism.
The immunological effects of vitamin D have increasingly come into focus.

Aims: To review the evidence supporting a role of vitamin D in inflammatory bowel diseases.

Methods: A comprehensive search was performed on PubMed using the terms ‘crohn's disease’ ‘ulcerative colitis’ and ‘vitamin D’.

Results: Vitamin D deficiency is common in patients with inflammatory bowel diseases (IBD) (16–95%) including those with recently diagnosed disease. Evidence supports immunological role of vitamin D in IBD. In animal models, deficiency of vitamin D increases susceptibility to dextran sodium sulphate colitis, while 1,25(OH)2D3 ameliorates such colitis. One prospective cohort study found low predicted vitamin D levels to be associated with an increased risk of Crohn's disease (CD). Limited data also suggest an association between low vitamin D levels and increased disease activity, particularly in CD. In a large cohort, vitamin D deficiency (<20 ng/mL) was associated with increased risk of surgery (OR 1.8, 95% CI 1.2–2.5) in CD and hospitalisations in both CD (OR 2.1, 95% CI 1.6–2.7) and UC (OR 2.3, 95% CI 1.7–3.1). A single randomised controlled trial demonstrated that vitamin D supplementation may be associated with reduced frequency of relapses in patients with CD compared with placebo (13% vs. 29%, P = 0.06).

Conclusions: There is growing epidemiological evidence to suggest a role for vitamin D deficiency in the development of IBD and also its influence on disease severity. The possible therapeutic role of vitamin D in patients with IBD merits continued investigation.

Clipped from PDF

Studies

Intervention: Crohn's and Ulcerative colitis

Table 4 | Unanswered clinical questions regarding the role of vitamin D in inflammatory bowel diseases

1. Does low serum vitamin D cause Crohn's disease or ulcerative colitis, or is it a marker for other risk factors?
2. . Can supplementation with vitamin D in high-risk individuals prevent or delay the onset of Crohn's disease or ulcerative colitis?
3. Does vitamin D deficiency cause a more severe phenotype or increased inflammatory activity in Crohn's disease,
   or is it merely a consequence of severity of disease?
   Is vitamin D status predictive of recurrence of Crohn's disease post-operatively?
4. What is the optimal role of vitamin D supplementation as a therapeutic modality in patients with IBD?
   Induction of remission?
   Maintenance of remission and prevention of relapse?
   Prevention of post-operative recurrence?
5. What is the optimal serum 25(OH)D level for its effect on inflammation in patients with IBD?
6. What is the optimal dose and modality for treatment of vitamin D deficiency in IBD patients?
7. Can vitamin D supplementation reduce risk of colorectal cancer in IBD?

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See also VitaminDWiki

• Inflammatory bowel diseases treated with vitamin D – Review May 2014
• Inflammatory bowel disease and vitamin D – review Aug 2012 previous article in same journal
• Irritable Bowel Syndrome: social media indicates that vitamin D is a good treatment – Oct 2013
• Crohn’s helped by 5000 IU vitamin D – April 2013
• 70 percent of people with IBS had symptoms relieved with high dose vitamin D – 2012
• IBD in Finland – 3X increase in 15 years, more prevalent further from equator – Nov 2012
• Overview Gut and vitamin D contains the following summary and chart (see lower left)
  *Gut problems result in reduced absorption of Vitamin D, Magnesium, etc.
• Celiac disease has a strong genetic component.
  • Most, but not all, people with celiac disease have a gene variant.
  • An adequate level vitamin D seems to decrease the probability of getting celiac disease.
  • Celiac disease causes poor absorption of nutrients such as vitamin D.
  • Bringing the blood level of vitamin D back to normal in patients with celiac disease decreases symptoms.
  • The prevalence of celiac disease, not just its diagnosis, has increased 4X in the past 30 years, similar to the increase in Vitamin D deficiency.
• Review in Nov 2013 found that Vitamin D helped
  Many intervention clinical trials with vitamin D for Gut problems (101 trials listed as of Sept 2019)
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