Review article: vitamin D and inflammatory bowel diseases

Abstract

Background Vitamin D is traditionally associated with bone metabolism. The immunologic 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 IBD (16–95%) including those with recently diagnosed disease. Evidence supports immunologic role of vitamin D in IBD. In animal models, deficiency of vitamin D increases susceptibility to DSS 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 CD. Limited data also suggests an association between low vitamin D levels and increased disease activity, particularly in Crohn’s disease. In a large cohort, vitamin D deficiency (< 20ng/mL) was associated with increased risk of surgery (OR 1.8, 95% CI 1.2 – 2.5) in CD and hospitalizations 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 randomized controlled trial demonstrated that vitamin D supplementation may be associated with reduced frequency of relapses in patients with Crohn’s disease compared to 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.

Vitamin D as a novel therapy in inflammatory bowel disease: new hope or false dawn?

“…The exact cause of IBD remains unknown; however, the disease is thought to result from a complex interaction between immunological, genetic and environmental factors. Vitamin D status is one such postulated environmental risk factor (24)(25)(26) . Epidemiological studies show a geographic variation in the incidence of IBD, with a higher incidence in countries of more northern latitudes, mirroring sunlight patterns and likely to reflect vitamin D levels.…”

Recurrent aphthous stomatitis: An overview

“…IgG, IgM, IgA, factor XIIIa+ dendrocytes, dendritic cells are involved in RAS formation. [31][32][33][34][35][36][37][38][39] Diagnosis and Differential Diagnosis of Recurrent Aphthous Stomatitis (RAS): There is no accurate diagnostic tool to rule out RAS from other mucosal lesions which are the manifestation of systemic disorders except family history and/or, clinical history. Diagnostic design is made to see if other disorders coincide with RAS.…”

Editorial: Vitamin D and IBD: Can We Get Over the “Causation” Hump?

“…A cursory search for publications on "Vitamin D AND IBD" on Pubmed reveals 144 publications (with 43 reviews) in the 5-year period between 2011 and 2015 compared with only 80 (with 23 reviews) in the 20 years between 1991 and 2010. Underlying this interest is the growing evidence of an infl uence of vitamin D beyond calcium absorption and bone health (1)(2)(3)(4)(5). Vitamin D through the binding of its active form 1,25-dihydroxy cholecalciferol to the nuclear vitamin D receptor (VDR) in the small intestine epithelium augments luminal absorption of calcium ( 4,6 ).…”

“…Underlying this interest is the growing evidence of an infl uence of vitamin D beyond calcium absorption and bone health (1)(2)(3)(4)(5). Vitamin D through the binding of its active form 1,25-dihydroxy cholecalciferol to the nuclear vitamin D receptor (VDR) in the small intestine epithelium augments luminal absorption of calcium ( 4,6 ). Th rough a similar eff ect on VDR on the osteoblasts, vitamin D increases the expression of the receptor activator for nuclear factor κ B ligand (RANKL) that binds with RANK and converts pre-osteoclasts to osteoclasts, facilitating bone turnover and maintenance of circulating calcium and phosphorous homeostasis ( 6 ).…”

“…In a prospective examination of the Nurses Health Study, those in the highest quartile of predicted vitamin D levels had a reduced risk of CD ( 11 ). In patients with established IBD, higher disease activity, need for hospitalizations, and surgery have all been associated with vitamin D defi ciency, although, in many cases, the question of whether the defi ciency preceded the severe outcomes, or if tenuous control of disease resulted in reduced physical activity or sunlight exposure leading to low vitamin D levels, is unclear ( 4,12 ). Apart from a possible association with disease activity, vitamin D defi ciency in patients with IBD has also been associated with increased risk of Clostridium diffi cile infection and with colorectal cancer, associations that have also been identifi ed in non-IBD populations and are supported by So where is the need in the fi eld?…”