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[Factors associated with hyperhomocysteinemia in inflammatory bowel disease: prospective study in 81 patients]
X Roblin1, E Germain, J M Phelip
1Département d'hépatogastroentérologie, département de biologie appliquée, CHU de Grenoble, France. XRoblin@chu-grenoble.fr
Insights
Hyperhomocysteinemia is common in inflammatory bowel disease (IBD), with low folate levels being the primary risk factor. Early detection and supplementation with folate and vitamin B12 are recommended for IBD patients to manage this condition and its potential link to colorectal cancer.
Area of Science:
- Gastroenterology
- Clinical Biochemistry
- Oncology
Context:
- Inflammatory Bowel Disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), is associated with a high prevalence of hyperhomocysteinemia.
- Risk factors for hyperhomocysteinemia in IBD patients are not consistently documented across studies.
- Understanding these factors is crucial for managing IBD complications.
Purpose:
- To prospectively evaluate hyperhomocysteinemia in IBD patients.
- To identify associated risk factors for hyperhomocysteinemia.
- To determine the potential risk of colorectal carcinoma in hyperhomocysteinemic IBD patients.
Summary:
- A prospective study included 81 IBD patients (60 CD, 21 UC), finding a 55.6% prevalence of high plasma homocysteine concentrations.
- Low folate levels were identified as the sole significant risk factor for hyperhomocysteinemia (OR = 3.59).
- Five patients with precancerous endoscopic lesions all exhibited hyperhomocysteinemia, suggesting a potential link to colorectal cancer.
Impact:
- This study highlights the high prevalence of hyperhomocysteinemia in both CD and UC.
- Low folate levels are confirmed as a key risk factor, necessitating screening and supplementation.
- The findings suggest a possible association between hyperhomocysteinemia and colorectal cancer in IBD patients, warranting further investigation and clinical attention.
Background:
A high prevalence (52%) of hyperhomocysteinemia is observed in Crohn disease (CD), however it is not well documented in ulcerative colitis (UC). Furthermore, in the different works studying hyperhomocysteinemia the associated factors are different.
Aim:
Prospective evaluation of hyperhomocysteinemia in inflammatory bowel disease (IBD) patients, of the risk factors and the determination of a potential risk of colorectal carcinoma in case of hyperhomocysteinemia.
Patients And Methods:
IBD patients followed in our department were prospectively recruited between November 2003-September 2004. To be included patients should have passed a coloscopy in the two years. Patients with kidney failure or drugs supposed, to interfere with homocystéine metabolism (folates, vitamin B12, methotrexate) were excluded from the study. The following parameters were analysed: age, sex, clinical activity indexes (CDAI for Crohn disease and CAI for ulcerative colitis), length-extent and type of the disease (CD or UC), smoking, plasma homocystein concentration, folates and vitamin B12.
Results:
Eighty-one patients (60 CD, 21 UC, mean age 43.8 +/- 17.3) were included, 30 had an active disease at inclusion and 16 were smokers. The prevalence of high homocystein concentration was 55.6%. In univariate analysis a low rate of folates was the only risk factor for a high homocystein concentration (74 vs. 52.8%; P = 0.018). Smoking was almost an associated factor. In multivariate analysis, a low rate of folate was the only risk factor of hyperhomocysteinemia, OR = 3.59 [1.27-10.17]. Five endoscopic lesions considered as precancerous were described; these patients had all a hyperhomocysteinemia.
Conclusion:
The prevalence of hyperhomocysteinemia is high in UC and in CD. A low folate rate is the only risk factor observed in our study. There is a possible link between colorectal cancer and hyperhomocysteinemia. A high Plasma homocystein concentration must be search in inflammatory bowel disease patients and a substitutive treatment of folates and vitamin B12 is necessary in case of hyperhomocysteinemia.
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