Higher vitamin D serum concentration increases health related quality of life in patients with inflammatory bowel diseases

AIM: To investigate the effect of vitamin D(VD) concentrations and VD supplementation on health related quality of life in inflammatory bowel disease(IBD) patients. METHODS: A cohort of 220 IBD patients including 141 Crohn's disease(CD) and 79 ulcerative colitis(UC) patients was followed-up at a tertiary IBD center. A subgroup of the cohort(n = 26) took VD supplements for > 3 mo. Health related quality of life was assessed using the short IBD questionnaire(s IBDQ). VD serum concentration and s IBDQ score were assessed between August and October 2012(summer/autumn period) and between February and April 2013(winter/spring period). The mean VD serum concentration and its correlation with disease activity of CD were determined for each season separately. In a subgroup of patients, the effects of VD supplementation on winter VD serum concentration, change in VD serum concentration from summer to winter, and winter s IBDQ score were analyzed.RESULTS: During the summer/autumn and the winter/spring period, 28% and 42% of IBD patients were VD-deficient(< 20 ng/m L), respectively. In the winter/spring period, there was a significant correlation between s IBDQ score and VD serum concentration in UC patients(r = 0.35, P = 0.02), with a trend towards significance in CD patients(r = 0.17, P = 0.06). In the winter/spring period, VD-insufficient patients(< 30 ng/m L) had a significantly lower mean s IBDQ score than VD-sufficient patients; this was true of both UC(48.3 ± 2.3 vs 56.7 ± 3.4, P = 0.04) and CD(55.7 ± 1.25 vs 60.8 ± 2.14, P = 0.04) patients. In all analyzed scenarios(UC/CD, the summer/autumn period and the winter/spring period), health related quality of life was the highest in patients with VD serum concentrations of 50-59 ng/m L. Supplementation with a median of 800 IU/d VD day did not influence VD serum concentration or the s IBDQ score.CONCLUSION: VD serum concentration correlated with health related quality of life in UC and CD patients during the winter/spring period.

Drug-induced liver injury in inflammatory bowel disease: 1-year prospective observational study

AIM To analyze 1-year liver injury burden in inflammatory bowel disease(IBD) patients. METHODS During a 6-mo inclusion period, consecutive IBD cases having a control visit at IBD center were included. Basic demographics, IBD phenotype and IBD treatment were recorded on entry. Aminotransferase(AT) activities of ALT, AST, ALP and gamma-glutamyl transpeptidase(GGT) were measured at baseline, 3 mo prior to study entry and prospectively every 3 mo for 1 year. Liver injury patterns were predefined as: Grade 1 in ALT 1-3 × upper limit of normal(ULN), grade 2 in ALT > 3 × ULN, hepatocellular injury in ALT > 2 × ULN, cholestatic injury in simultaneous GGT and ALP elevation > ULN.Persisting injury was reported when AT elevations were found on > 1 measurement. Risk factors for the patterns of liver injury were identified among demographic parameters, disease phenotype and IBD treatment in univariate and multivariate analysis. Finally, implications for the change in IBD management were evaluated in cases with persisting hepatocellular or cholestatic injury.RESULTS Two hundred and fifty-one patients were included having 917 ALT and 895 ALP and GGT measurements. Over one year, grade 1 injury was found in 66(26.3%), grade 2 in 5(2%) and hepatocellular injury in 16 patients(6.4%). Persisting hepatocellular injury was found in 4 cases. Cholestasis appeared in 11 cases(4.4%) and persisted throughout the entire study period in 1 case. In multivariate analysis, hepatocellular injury was associated with BMI(OR = 1.13, 1.02-1.26), liver steatosis(OR = 10.61, 2.22-50.7), IBD duration(1.07, 1.00-1.15) and solo infliximab(OR = 4.57, 1.33-15.7). Cholestatic liver injury was associated with prior intestinal resection(OR = 32.7, 3.18-335), higher CRP(OR = 1.04, 1.00-1.08) and solo azathioprine(OR = 10.27, 1.46-72.3). In one case with transient hepatocellular injury azathioprine dose was decreased. In 4 cases with persisting hepatocellular injury, fatty liver or alcohol were most likely causes and IBD treatment was pursued without change. In the case with persisting cholestatic injury, no signs of portal hypertension were identified and treatment with infliximab continued.CONCLUSION Liver injury was frequent, mostly transient and rarely changed management. Infliximab or azathioprine were confirmed as its risk factors indicating the need for regular AT monitoring.