The effect of vitamin D on haemoglobin, patient assessed disease activity and endoscopic assessment in ulcerative colitis patients with anaemia

Komal Dalal; Sarita Goyal; Sandeep Goyal

doi:10.18203/2319-2003.ijbcp20231891

Authors

Komal Dalal Department of Pharmacology, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
Sarita Goyal Department of Pharmacology, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
Sandeep Goyal Department of Medicine, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India

DOI:

https://doi.org/10.18203/2319-2003.ijbcp20231891

Keywords:

Anemia, Vitamin D, Haemoglobin

Abstract

Background: Anemia has a dramatic impact on patient's quality of life, yet anemia in patients with UC is still underdiagnosed and undertreated. Hepcidin has been identified to be a central regulator of iron absorption from the intestines and of plasma iron levels. In this study we evaluated the effect of vitamin D supplementation on haemoglobin levels, patient assessed disease activity and endoscopic assessment in ulcerative colitis (UC).

Methods: In this prospective, open-labeled, parallel-group, randomized, comparative clinical study, we assigned newly diagnosed cases of UC with haemoglobin levels between 8-11 gm/dL to receive either standard therapy for 12 weeks or to receive oral 4000IU vitamin D3 along with standard therapy for 12 weeks.

Results: Data from 60 patients were analyzed after 12 weeks. Supplementation with vitamin D3 significantly raised haemoglobin level in treatment group from (9.09±0.20) (Mean ± SEM) at baseline to 9.62±0.22 (Mean ± SEM) at 12 weeks. On assessment of abdominal pain with NRS scale at the end of treatment at 12 weeks the reduction in NRS score was to 3.47±0.29 in group I and to 2.23±0.21 in group II (p=0.0012) which was highly significant. There was also a statistically significant reduction in the Likert scale at the end of 4, 8 and 12 weeks in both groups. At week 12, there was no statistical difference between the two groups in improving the endoscopy score.

Conclusions: Daily high dose vitamin D supplementation is beneficial in ameliorating UC symptoms like abdominal pain and has a positive effect on haemoglobin levels.

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References

Crohn's and Colitis Foundation of Canada. The impact of inflammatory bowel disease in Canada: Final Report and Recommendations. 2012.

Ormerod TP. Anaemia in ulcerative colitis. Proc R Soc Med. 1968;61(9):931.

Oldenburg B, Koningsberger JC, Van Berge Henegouwen GP, Van Asbeck BS, Marx JJ. Iron and inflammatory bowel disease. Aliment Pharmacol Ther. 2001;15(4):429-38.

Stein J, Hartmann F, Dignass AU. Diagnosis and management of iron deficiency anemia in patients with IBD. Nat Rev Gastroenterol Hepatol. 2010;7(11):599-610.

Erichsen K, Hausken T, Ulvik RJ, Svardal A, Berstad A, Berge RK. Ferrous fumarate deteriorated plasma antioxidant status in patients with Crohn disease. Scand J Gastroenterol. 2003;38(5):543-8.

Bacchetta J, Zaritsky JJ, Sea JL, Chun RF, Lisse TS, Zavala K et al. Suppression of iron-regulatory hepcidin by vitamin D. J Am Soc Nephrol. 2014;25(3):564-72.

Kendrick J, Targher G, Smits G, Chonchol M. 25-Hydroxyvitamin D deficiency and inflammation and their association with hemoglobin levels in chronic kidney disease. Am J Nephrol. 2009;30(1):64-72.

Reinisch W, Staun M, Bhandari S, Muñoz M. State of the iron: how to diagnose and efficiently treat iron deficiency anemia in inflammatory bowel disease. J Crohns Colitis. 2013;7(6):429-40.

Smith EM, Alvarez JA, Kearns MD, Hao L, Sloan JH, Konrad RJ et al. High-dose vitamin D3 reduces circulating hepcidin concentrations: A pilot, randomized, double-blind, placebo-controlled trial in healthy adults. Clin Nutr. 2017;36(4):980-5.

Ernst JB, Prokop S, Fuchs U, Dreier J, Kuhn J, Knabbe C et al. Randomized supplementation of 4000-IU vitamin D 3 daily vs placebo on the prevalence of anemia in advanced heart failure: the EVITA trial. Nutr J. 2017;16:1-9.

Smith EM, Jones JL, Han JE, Alvarez JA, Sloan JH, Konrad RJ et al. High-Dose Vitamin D3 administration is associated with increases in hemoglobin concentrations in mechanically ventilated critically ill adults: A pilot double-blind, randomized, placebo-controlled trial. J Parenter Enteral Nutr. 2018;42(1):87-94.

Syed S, Michalski ES, Tangpricha V, Chesdachai S, Kumar A, Prince J, et al. Vitamin D status is associated with hepcidin and hemoglobin concentrations in children with inflammatory bowel disease. Inflam Bowel Dis. 2017;23(9):1650-8.

Garcia PM, Moore J, Kahan D, Hong MY. Effects of vitamin D supplementation on inflammation, colonic cell kinetics, and microbiota in colitis: a review. Molecules. 2020;25(10):2300.

Frigstad SO, Høivik ML, Jahnsen J, Cvancarova M, Grimstad T, Berset IP et al. Pain severity and vitamin D deficiency in IBD patients. Nutrients. 2019;12(1):26.

Zielińska A, Sobolewska-Włodarczyk A, Wiśniewska-Jarosińska M, Gąsiorowska A, Fichna J, Sałaga M. The 25(OH)D3, but not 1,25(OH)2D3 levels are elevated in IBD patients regardless of vitamin D supplementation and do not associate with pain severity or frequency. Pharmaceuticals (Basel). 2021;14(3):284.

Harbord M, Annese V, Vavricka SR, Allez M, Barreiro-de Acosta M, Boberg KM et al. The first European evidence-based consensus on extra-intestinal manifestations in inflammatory bowel disease. J Crohns Colitis. 2016;10(3):239-54.

Garg M, Hendy P, Ding JN, Shaw S, Hold G, Hart A. The effect of vitamin D on intestinal inflammation and faecal microbiota in patients with ulcerative colitis. J Crohns Colitis. 2018;12:963-72.

Goulart RA, Barbalho SM. Can vitamin D induce remission in patients with inflammatory bowel disease? Ann Gastroenterol. 2022;35(2):140-9.