PRM38 Estimation of a Markov Chain for Crohn's Disease and Classification of Patients Into Disease Phenotypes, in Eight Countries Using Individual Longitudinal Data Aggregated Over Time

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Low serum and bone vitamin K status in patients with longstanding Crohn's disease: another pathogenetic factor of osteoporosis in Crohn's disease?

BACKGROUND—A high prevalence of osteoporosis is reported in Crohn's disease. The pathogenesis is not completely understood but is probably multifactorial. Longstanding Crohn's disease is associated with a deficiency of fat soluble vitamins, among them vitamin K. Vitamin K is a cofactor in the carboxylation of osteocalcin, a protein essential for calcium binding to bone. A high level of circulating uncarboxylated osteocalcin is a sensitive marker of vitamin K deficiency.
AIMS—To determine serum and bone vitamin K status in patients with Crohn's disease and to elucidate its relationship with bone mineral density.
METHODS—Bone mineral density was measured in 32 patients with longstanding Crohn's disease and small bowel involvement, currently in remission, and receiving less than 5 mg of prednisolone daily. Serum levels of vitamins D and K, triglycerides, and total immunoreactive osteocalcin, as well as uncarboxylated osteocalcin ("free" osteocalcin) were determined. The hydroxyapatite binding capacity of osteocalcin was calculated. Data were compared with an age and sex matched control population.
RESULTS—Serum vitamin K levels of CD patients were significantly decreased compared with normal controls (p<0.01). "Free" osteocalcin was higher and hydroxyapatite binding capacity of circulating osteocalcin was lower than in matched controls (p<0.05 and p<0.001, respectively), indicating a low bone vitamin K status in Crohn's disease. In patients, an inverse correlation was found between "free" osteocalcin and lumbar spine bone mineral density (r=−0.375, p<0.05) and between "free" osteocalcin and the z score of the lumbar spine (r=−0.381, p<0.05). Multiple linear regression analysis showed that "free" osteocalcin was an independent risk factor for low bone mineral density of the lumbar spine whereas serum vitamin D was not.
CONCLUSIONS—The finding that a poor vitamin K status is associated with low bone mineral density in longstanding Crohn's disease may have implications for the prevention and treatment of osteoporosis in this disorder.


Keywords: Crohn's disease; bone mineral density; vitamin K; osteocalci

Screenee perception and health-related quality of life in colorectal cancer screening: a review

The incidence of colorectal cancer (CRC) has increased sharply in the Western world from 1970 (1). A steady increase of environmental risk factors for CRC (obesity, smoking, low physical activity, poor diet) has called for CRC prevention not only in Western Countries, but recently also in Asia (2). This has resulted in an appeal from the European Commission to its member states to establish CRC screening programmes nation-wide. At present, this recommendation has been followed to varying degrees: with a particular eagerness of some East-European countries in which the level of CRC incidence was particularly high (3), but with hesitation and slowness in some others West-European countries with a similar incidence (1). FOBT has traditionally been the most common test used in CRC screening, but in later years sigmoidoscopy or colonoscopy have become increasingly popular. In the US and in Germany, colonoscopy is strongly promoted as first-line screening method, whereas a pre-screening with FOBT and sigmoidoscopy is recommended in others, such as the United Kingdom. Differences in screening recommendations are motivated to some extent by organisational and economic reasons, but also by the scarcely documented public presumption that the more invasive endoscopic procedure might create negative perceptions and impair the Health-related Quality of Life (HRQoL) of potential screenees. Frequently the medical community shares this worry and tends to favour less burdensome (but also less sensitive) imaging procedures for CRC screening such as CT-colonography. Non-evidence-based opinions can survive for long periods, not only in general but also in professional communities and, can potentially inhibit beneficial medical developments