Terminal ileum resection is associated with higher plasma homocysteine levels in Crohn's disease.
BACKGROUND
Elevated plasma total homocysteine (tHcy) is associated with a higher risk of thrombosis. Crohn's disease (CD) is associated with hypercoagulability of undefined etiology. We investigated tHcy in patients with CD and its relationship with vitamin status, disease activity, location, duration, and history of terminal ileum (TI) resection.


METHODS
We examined fasting plasma tHcy, folate, serum vitamin B12 levels, and sedimentation rate in consecutive adult patients with CD. Harvey-Bradshaw index of CD activity and history of TI resection and thromboembolism were recorded.


RESULTS
Median plasma tHcy was 10.2 micromol/L in 125 patients with CD. Men (n = 60) had higher plasma tHcy than women (n = 65) (11.2 vs. 9.1 micromol/L; p = 0.004). Patients with a history of TI resection showed lower serum B12 levels (293 vs. 503 pg/mL; p < 0.001) and higher plasma tHcy levels (11.0 vs. 9.35 micromol/L; p = 0.027) than patients without such history. Multivariate analysis showed history of TI resection, serum B12, and creatinine levels to be significant predictors of elevated plasma tHcy. Fourteen patients with CD with a history of thrombosis had an elevated median plasma tHcy of 11.6 micromol/L.


CONCLUSIONS
Terminal ileum resection contributes to elevated plasma tHcy levels in CD cases. We recommend tHcy screening in patients with CD, especially in those with prior history of TI resection, and the initiation of vitamin supplementation when appropriate.
Vasilopoulos
S
S
Division of Gastroenterology and Hepatology, Department of Medicine, Froedtert Memorial Lutheran Hospital, Digestive Disease Center, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA.
Saiean
K
K
Emmons
J
J
Berger
W L
WL
Abu-Hajir
M
M
Seetharam
B
B
Binion
D G
DG
D000328:Adult; D001799:Blood Sedimentation; D003404:Creatinine / Q000097:blood; D003424:Crohn Disease / Q000097:blood / Q000601:surgery*; D005260:Female; D005492:Folic Acid / Q000097:blood; D005500:Follow-Up Studies; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D007082:Ileum / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D019851:Thrombophilia / Q000097:blood; D014805:Vitamin B 12 / Q000097:blood
D006710:Homocysteine; D005492:Folic Acid; D003404:Creatinine; D014805:Vitamin B 12