ABSTRACT
ABSTRACTBackground:Vitamin D deficiency is commonly seen in patients with inflammatory bowel disease (IBD). Vitamin D deficiency in IBD patients with ileostomy has not been systemically studied. The aim of the study was to assess the frequency and risk factors associated with low 25(OH) D3 levels in those patients.Methods:112 eligible IBD patients with ileostomy were studied. Demographic, clinical, and endoscopic variables were analyzed. Vitamin D levels before and after ileostomy were compared when available. Levels of serum 25(OH)D3 <20 ng/mL were classed as being deficient.Results:112 eligible ileostomy patients were included. The mean vitamin D level was 21.47 ± 1.08 ng/dl. Low levels of vitamin D (<30 ng/dl) were present in 92 patients (82%). Vitamin D deficiency (<20 ng/dL) was seen in 55 patients (49%). There was no difference between patients with or without vitamin D deficiency regarding demographic variables, medication use and duration of ileostomy. Neo-ileal inflammation on endoscopy was not associated with vitamin D deficiency (p= 0.155). Lower levels of phosphorus (p= 0.020) or hemoglobin (p= 0.019) and shorter duration of IBD (p= 0.047) were found in patients with vitamin D deficiency. In multivariate analysis, lower levels of phosphorus (odds ratio [OR]: 1.83, 95% confidence interval [CI]: 1.16-2.89, p= 0.009) and hemoglobin (OR: 1.32, 95% CI: 1.08-1.60, p= 0.006) remained significantly associated with vitamin D deficiency.Conclusion:Vitamin D deficiency is common in IBD patients with ileostomy and is associated with low hemoglobin levels. Further studies are needed to evaluate vitamin D supplementation as a possible adjuvant in the treatment of anemia of chronic disease in IBD patients.
RESUMOIntrodução:A deficiência de vitamina D em pacientes com doença inflamatória intestinal submetidos a ileostomia não foi estudada sistematicamente. O objetivo desse estudo foi avaliar a frequência e os fatores de risco associados com a deficiência de vitamina D nesses pacientes.Resultados:112 pacientes elegíveis foram incluídos. A média dos níveis de vitamina D na população estudada foi de 21.47 ± 1.08 ng/dl. Níveis de vitamina D abaixo do normal (<30 ng/dl) e deficiência de vitamina D (<20 ng/dL) foram encontrados em 92 pacientes (82%) e em 55 pacientes (49%) respectivamente. Encontrou-se uma associação entre deficiência de vitamina D e níveis mais baixos de fosforo (p = 0.020), hemoglobina (p = 0.019) e duração da doença inflamatória intestinal (p = 0.047). Na análise multivariada, níveis mais baixos de fósforo (odds ratio [OR]: 1.83, 95% confidence interval [CI]: 1.16-2.89, p = 0.009) e hemoglobina (OR: 1.32, 95% CI: 1.08-1.60, p = 0.006) permaneceram associados com deficiência de vitamina D.Conclusão:A deficiência de vitamina D é comum em pacientes com doença inflamatória intestinal submetidos a ileostomia e está associada com níveis baixos de hemoglobina. Mais estudos são necessários para avaliar se a suplementação de vitamina D pode ser um adjuvante no tratamento de anemia da doença crônica nesses pacientes.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Vitamin D Deficiency , Ileostomy , Inflammatory Bowel Diseases , Anemia , Health Profile , Data Interpretation, StatisticalABSTRACT
Helicobacter pylori causes chronic gastric inflammation and significantly increases the risk of duodenal and gastric ulcer disease and distal gastric carcinoma. In this study, we evaluated the Helicobacter pylori vacA and cagA genotypes in patients from a Brazilian region where there is a high prevalence of gastric cancer. Polymerase chain reaction (PCR) was used to investigate vacA mosaicism and cagA status in the gastric mucosa of 134 H. pylori-positive patients, including 76 with gastritis: 28 with peptic ulcer disease and 30 with gastric cancer. The s1m1 variant was the predominant vacA genotype observed, whereas the s1 allele was more frequently observed in patients with more severe diseases associated with H. pylori infection [p = 0.03, odds ratio (OR) = 5.72, 95% confidence interval (CI) = 1.15-38.60]. Furthermore, all of the s1 alleles were s1b. Mixed vacA m1/m2 strains were found more frequently in patients with gastric cancer and a cagA-positive status was significantly associated with gastric cancer (p = 0.016, OR = 10.36, 95% CI = 1.35-217.31). Patients with gastric cancer (21/21, 100%, p = 0.006) or peptic ulcers (20/21, 95%, p = 0.02) were more frequently colonised by more virulent H. pylori strains compared to gastritis patients (41/61, 67.2%). In conclusion, in the northeastern of Brazil, which is one of the regions with the highest prevalence of gastric cancer in the country, infection with the most virulent H. pylori strains, carrying the cagA gene and s1m1 vacA alleles, predominates and is correlated with more severe H. pylori-associated diseases.