title: Association of hyperhomocysteinemia and folate deficiency with colon tumors in patients with inflammatory bowel disease.
abstract: BACKGROUND
  Folate deficiency associated with hyperhomocysteinemia might increase the risk of developing colorectal cancer. The aim of this study was to evaluate factors associated with colonic carcinogenesis, in particular, folate and homocysteinemia levels, in a cross-sectional study of patients with inflammatory bowel disease (IBD).
  
  
  METHODS
  IBD patients with carcinogenic lesions discovered during colonoscopy [dysplasia-associated lesion or masses (DALM), colorectal cancer] were included and compared with the whole population of IBD patients with a normal colonoscopy performed during the same period. The following parameters were collected at the time of colonoscopy: age, sex, type, duration, activity, and extent of the disease, treatment, smoking status, and vitamin B12, folate, and homocysteinemia levels. Univariate and multivariate analyses were performed after adjusting for the main parameters.
  
  
  RESULTS
  One hundred and fourteen patients [41 with ulcerative colitis (UC), 73 with Crohn's disease (CD)] were included. Twenty-six carcinogenic lesions were isolated: 18 DALM (7 high-grade and 11 low-grade dysplasia) and 8 colorectal cancers. In univariate analysis, the factors associated with carcinogenesis were: active smoking (P = 0.03), folate level < 145 pmol/L (P = 0.02), hyperhomocysteinemia > 15 micromol/L (P = 0.003), duration of disease > 10 years (P = 0.006), and UC (P = 0.02). In multivariate analysis, patients with hyperhomocysteinemia associated with folate deficiency had 17 times as many carcinogenic lesions as patients with normal homocysteinemia whatever the folate status and duration of the disease (P = 0.01). Patients with hyperhomocysteinemia without folate deficiency had 2.5 times as many carcinogenic lesions as patients with normal homocysteinemia (P = 0.08).
  
  
  CONCLUSIONS
  Our data suggest that in IBD patients with normal homocysteinemia, the increase in carcinogenic risk is negligible. Conversely, in patients with hyperhomocysteinemia, folate deficiency may be associated with increased colorectal carcinogenesis in IBD patients.
authors.affiliation: Department of Gastroenterology, University Hospital of Grenoble, France. JMPhelip@chu-grenoble.fr
authors.forename: Jean Marc
authors.initials: JM
authors.lastname: Phelip
authors.forename: Veronique
authors.initials: V
authors.lastname: Ducros
authors.forename: Jean Luc
authors.initials: JL
authors.lastname: Faucheron
authors.forename: Bernard
authors.initials: B
authors.lastname: Flourie
authors.forename: Xavier
authors.initials: X
authors.lastname: Roblin
mesh_terms: D000328:Adult; D003110:Colonic Neoplasms / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D003430:Cross-Sectional Studies; D005260:Female; D005494:Folic Acid Deficiency / Q000150:complications*; D005602:France / Q000453:epidemiology; D006801:Humans; D020138:Hyperhomocysteinemia / Q000150:complications*; D015212:Inflammatory Bowel Diseases / Q000150:complications*; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D012307:Risk Factors