Mihaela Dranga

Serum 25-hydroxyvitamin D concentration and inflammatory bowel disease characteristics in Romania

AIM To describe the relationship between vitamin D levels and inflammatory bowel disease (IBD) characteristics in northeastern Romanian patients. METHODS This was a prospective study of 47 consecutive IBD patients admitted to The Institute of Gastroenterology and Hepatology in Iasi, Romania between March 2011 and June 2012. The diagnosis of IBD was established based on endoscopic, histologic and radiologic findings. Demographic data, disease characteristics, ongoing treatments and biological parameters of patients (including markers of inflammation: C-reactive protein level, fibrinogen level, and erythrocyte sedimentation rate) were recorded. Serum vitamin D levels were measured and compared with age- and sex-matched healthy volunteers from the same geographic area. Vitamin D levels were defined as sufficient (> 30 ng/mL), insufficient (20-30 ng/mL), or severely deficient (< 20 ng/mL). RESULTS Thirty-three of the IBD patients included in this study had ulcerative colitis (UC) and 14 had Crohns disease (CD). Only 24% of the UC patients and 21% of the CD patients had sufficient vitamin D levels. The vitamin D levels were significantly lower in the CD patients with moderate to severe disease activity compared to the CD patients in remission or with mild disease activity (16 ± 6 ng/mL vs 26 ± 7 ng/mL; 16 ± 6 ng/mL vs 31 ± 9 ng/mL, respectively, P < 0.05). Vitamin D levels in the UC patients were not influenced by disease activity and no correlation was observed with the inflammation markers tested (C-reactive protein, fibrinogen, and erythrocyte sedimentation rate). No association was observed between vitamin D levels and smoking status or ongoing medication (5ASA, steroids, and anti-TNFα). Newly diagnosed IBD patients had lower vitamin D levels than patients with established cases, though these differences were not significant (UC: 22 ± 9 ng/mL vs 26 ± 12 ng/mL; CD: 18 ± 6 ng/mL vs 27 ± 11 ng/mL, respectively). Although no association was found between the season during which the visit was scheduled and vitamin D levels, the UC patients assessed during the winter tended to have lower levels than those assessed during the summer (22 ± 9 ng/mL vs 28 ± 13 ng/mL, respectively). CONCLUSION Vitamin D levels are significantly reduced in IBD patients in northeastern Romania, with the lowest levels occurring in CD patients with moderate to severe disease activity.

Bidirectional Relationship between Gastric Emptying and Plasma Glucose Control in Normoglycemic Individuals and Diabetic Patients

Gastric emptying and glycemic control pathways are closely interrelated processes. Gastric chyme is transferred into the duodenum with velocities depending on its solid or liquid state, as well as on its caloric and nutritional composition. Once nutrients enter the intestine, the secretion of incretins (hormonal products of intestinal cells) is stimulated. Among incretins, glucagon-like peptide-1 (GLP-1) has multiple glycemic-regulatory effects that include delayed gastric emptying, thus triggering a feedback loop lowering postprandial serum glucose levels. Glycemic values also influence gastric emptying; hyperglycemia slows it down, and hypoglycemia accelerates it, both limiting glycemic fluctuations. Disordered gastric emptying in diabetes mellitus is understood today as a complex pathophysiological condition, with both irreversible and reversible components and high intra- and interindividual variability of time span and clinical features. While limited delays may be useful for reducing postprandial hyperglycemias, severely hindered gastric emptying may be associated with higher glycemic variability and worsened long-term glycemic control. Therapeutic approaches for both gastric emptying and glycemic control include dietary modifications of meal structure or content and drugs acting as GLP-1 receptor agonists. In the foreseeable future, we will probably witness a wider range of dietary interventions and more incretin-based medications used for restoring both gastric emptying and glycemic levels to nearly physiological levels.

PROTON PUMP INHIBITORS BETWEEN BENEFITS AND RISKS

PROTON PUMP INHIBITORS BETWEEN BENEFITS AND RISKS (Abstract): Proton pump inhibitors (PPI) have been widely used since 1989 because they are highly effective for acidrelated conditions. As a class, PPIs are among the safest of pharmacologic agents. In the last years concerns have risen regarding potential of adverse events due to PPI use. These include cancer risk (stomach and colorectal cancer), infection risk (pneumonia, Clostridium difficile associated diarrhea, small intestinal bacterial overgrowth, spontaneous bacterial peritonitis, interstitial nephritis), metabolic effects on bone density with osteoporotic fractures, alteration of absorption of vitamins and minerals and the pharmacodynamic interaction with the metabolism of other medications by the hepatic cytochrome P450 enzyme systems (e.g., clopidogrel). Almost the entire evidence base regarding the safety of PPI therapy is composed of retrospective nonrandomized studies that demonstrate association but not causality and are limited by potential confounding factors. There is no evidence to support any benefit of changing existing clinical practice for preventing any of the potential adverse effects associated with PPI therapy. Therefore, in patients with appropriate indications for PPI, we should avoid continuous and high-dose therapy, considering on-demand therapy in suitable patients and step-down strategy.

P118 Vitamin D status and bone mineral density in patients recently diagnosed with ulcerative colitis

Background: Introduction: Inflammatory bowel diseases (IBD) are associated with an increased prevalence of decreased bone mineral density. One of the risk factors for the low bone mineral density is the inadequate level of 25 OH vitamin D. The aim of this study was to evaluate bone mineral density and level 25 OH vitamin D in patients recently diagnosed with UC. Methods: A prospective study was performed in The Center of Gastroenterology and Hepatology and included patients recently diagnosed with UC. We noted demographic and clinical data (age, sex, extent of lesions, the degree of disease activity and treatment). 25 OH vitamin D level was measured in all patients and dual-energy X-ray absorptiometry (DEXA) was performed at lumbar level and femoral neck. Results: 134 patients with UC were included; they had an average age of 46.21 years and were mostly men (59.7%) with an average evolution of the disease about 4 years (65% with an evolution <1.5 years or recently diagnosed). Most patients had extensive forms of the disease (56% left colitis, pancolitis 25.4%). In terms of disease activity: 29.9% had severe activity, 32.8% moderate, 23.9% mild and 13.4% were in clinical and biological remission. 29.1% of patients required treatment with oral or intravenous corticosteroids for about 4 months. Based on the lumbar and femoral neck osteodensitometry: 33.58% had normal BMD, 48.5% osteopenia and 17.91% osteoporosis. 25 OH vitamin D level was insufficient (<30 ng/ml) in 47% patients, normal in 31.34% patients, and 29 patients (21.64%) presented sever 25 OH vitamin D deficiency (<20 ng/ml). Conclusions: Decreased bone mineral density occurs early after the diagnosis of UC. Vitamin D deficiency is induced by extensive lesions and also by the inflammatory process. Vitamin D deficiency and the use of corticosteroids represent important risk factors in the development of bone demineralization in patients newly diagnosed with UC.