Intestinal absorption of cholecalciferol and 25-hydroxycholecalciferol in patients with both Crohn's disease and intestinal resection

Abstract

We compared the intestinal absorption of cholecalciferol and 25-hydroxycholecalciferol in patients with Crohn's disease and resections of the small bowel. Patients were subgrouped into those with small (less than 100 cm), intermediate (100-300 cm), and large (greater than 300 cm) resections. [3H]cholecalciferol or [3H]25-hydroxycholecalciferol were given orally and serial blood samples were taken for measurement of plasma radiolabeled vitamin. Absorption of both forms of the vitamin decreased with extent of resection but 25-hydroxycholecalciferol absorption was always greater than that of cholecalciferol. When compared with normal control subjects, 25-hydroxycholecalciferol absorption in these patients was better maintained than that of cholecalciferol. These data indicate that vitamin D malabsorption reflects the extent of distal small-bowel resection in Crohn's disease. Treatment with oral cholecalciferol is sufficient in those with small or moderate resections but oral 25-hydroxycholecalciferol supplementation may be preferred in those with a severe short-bowel syndrome.

Lower Levels of Vitamin D Correlate With Clinical Disease Activity and Quality of Life in Inflammatory Bowel Disease

“…Terminal ileal resection was associated with vitamin D deficiency in some studies (20,31) , which is thought to be a result of the interruption of the enterohepatic circulation in the terminal ileum, reducing the absorption of fats and fat-soluble vitamins, such as vitamin D (24) . However, the effect of ileal resection in vitamin D deficiency has not been consistently observed (33) and our results did not find an association between ileal resection and vitamin D deficiency.…”

Vitamin D Status in Children and Young Adults With Inflammatory Bowel Disease

“…Other studies report that smoking 21 and small bowel resection 30,32 are also negatively correlated with 25OHD concentration, whereas sunlight exposure and nutritional status are positively correlated. 29 Fewer studies have described the vitamin D status of adults with UC compared with those with CD.…”

“…21,22,24,26 One study reports a negative relationship among disease duration, Crohn Disease Activity Index, ferritin, C-reactive protein, cholesterol, 24 and 25OHD concentration. Other studies report that smoking 21 and small bowel resection 30,32 are also negatively correlated with 25OHD concentration, whereas sunlight exposure and nutritional status are positively correlated. 29 Fewer studies have described the vitamin D status of adults with UC compared with those with CD.…”

Vitamin D Therapy in Inflammatory Bowel Diseases: Who, in What Form, and How Much?

“…32 Vitamin D absorption is especially impaired in patients with previous ileal resections. 35,36,138 Treatment with oral cholecalciferol has been shown to be sufficient in patients with small or moderate resections (<300 cm), although other options, such as parenteral or oral 25-hydroxycholecalciferol supplementation, may be preferred in patients with severe short-bowel syndrome. 35 Topical applications of vitamin D have not yet been tested in patients with IBD.…”