Review Article: Vitamin D and Inflammatory Bowel Disease

Established Concepts and Future Directions

M. Garg; J. S. Lubel; M. P. Sparrow; S. G. Holt; P. R. Gibson

Disclosures

Aliment Pharmacol Ther. 2012;36(4):324-344. 

In This Article

Abstract and Introduction

Abstract

Background Understanding of the role of vitamin D in health and disease has increased markedly in the past decade, with its involvement extending well beyond traditional roles in calcium and phosphate homeostasis and musculoskeletal health. This conceptual expansion has been underpinned by identification and exploration of components of this axis including vitamin D-binding protein, key enzymes and receptors in multiple cell types, and a greater recognition of nonclassical autocrine and paracrine effects. Its influence in IBD remains uncertain.
Aim To review the role of vitamin D in bone health, immune regulation and cancer prevention in IBD, and to outline practical issues and limitations of its use.
Methods An extensive online literature review including PubMed and Medline.
Results In patients with IBD, the vitamin D axis provides an important and often underutilised pathway to preserving bone health. Furthermore, an exciting body of clinical and basic science research demonstrates that these pathways may have an integral part to play in regulation of the immune response in IBD, through effects on the intestinal barrier, antigen presenting cells and adaptive T cells. The possibility of chemoprevention requires further study. The optimal target level of 25-hydroxy vitamin D in patients with IBD is currently uncertain, as is the best therapeutic modality.
Conclusions Study of vitamin D pathways may result in the development of relatively inexpensive therapeutic options to optimise patient outcomes. Further prospective clinical research is required to address efficacy and long-term safety.

Introduction

Inflammatory bowel disease (IBD), comprising Crohn's disease (CD) and ulcerative colitis (UC), is a group of debilitating conditions associated with a dysregulated mucosal immune response to intestinal microorganisms in a genetically susceptible host. These conditions affect up to 0.5% of the population in developed countries and an increasing proportion in developing nations.[1–3] Apart from local intestinal complications, patients with IBD are at increased risk of systemic immune-related phenomena, nutritional deficiencies and bone disease, particularly osteoporosis.

Vitamin D is well recognised for its involvement in calcium homeostasis and musculoskeletal health. In addition, our understanding of its role in a variety of other systems and pathologies has rapidly expanded in the past decade. A wealth of in vitro and emerging clinical data suggests it may play a role in effective immune response, cardiovascular and renal physiology and protection against some cancers. This review will address physiological aspects of vitamin D and their relevance to IBD.

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