Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy.
Division of Endocrinology, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy.
Rev Endocr Metab Disord. 2023 Apr;24(2):121-138. doi: 10.1007/s11154-023-09792-7. Epub 2023 Feb 23.
This paper is one of the outcomes of the 5th International Conference "Controversies in Vitamin D" held in Stresa, Italy from 15 to 18 September 2021 as part of a series of annual meetings which was started in 2017. The scope of these meetings is to discuss controversial issues about vitamin D. Publication of the outcomes of the meeting in international journals allows a wide sharing of the most recent data with the medical and academic community. Vitamin D and malabsorptive gastrointestinal conditions was one of the topics discussed at the meeting and focus of this paper. Participants to the meeting were invited to review available literature on selected issues related to vitamin D and gastrointestinal system and to present their topic to all participants with the aim to initiate a discussion on the main outcomes of which are reported in this document. The presentations were focused on the possible bidirectional relationship between vitamin D and gastrointestinal malabsorptive conditions such as celiac disease, inflammatory bowel diseases (IBDs) and bariatric surgery. In fact, on one hand the impact of these conditions on vitamin D status was examined and on the other hand the possible role of hypovitaminosis D on pathophysiology and clinical course of these conditions was also evaluated. All examined malabsorptive conditions severely impair vitamin D status. Since vitamin D has known positive effects on bone this in turn may contribute to negative skeletal outcomes including reduced bone mineral density, and increased risk of fracture which may be mitigated by vitamin D supplementation. Due to the immune and metabolic extra-skeletal effects there is the possibility that low levels of vitamin D may negatively impact on the underlying gastrointestinal conditions worsening its clinical course or counteracting the effect of treatment. Therefore, vitamin D status assessment and supplementation should be routinely considered in all patients affected by these conditions. This concept is strengthened by the existence of a possible bidirectional relationship through which poor vitamin D status may negatively impact on clinical course of underlying disease. Sufficient elements are available to estimate the desired threshold vitamin D level above which a favourable impact on the skeleton in these conditions may be obtained. On the other hand, ad hoc controlled clinical trials are needed to better define this threshold for obtaining a positive effect of vitamin D supplementation on occurrence and clinical course of malabsorptive gastrointestinal diseases.
本文是 2021 年 9 月 15 日至 18 日在意大利斯特雷萨举行的第 5 届“维生素 D 争议”国际会议的成果之一，作为 2017 年开始的年度会议系列的一部分。这些会议的范围是讨论关于维生素 D 的有争议的问题。会议结果在国际期刊上发表，使医学界和学术界能够广泛分享最新数据。维生素 D 和吸收不良的胃肠道疾病是会议讨论的主题之一，也是本文的重点。会议邀请参与者审查与维生素 D 和胃肠道系统相关的选定问题的现有文献，并向所有参与者介绍他们的主题，目的是就主要结果展开讨论，本文报告了这些结果。演讲集中在维生素 D 和胃肠道吸收不良疾病（如乳糜泻、炎症性肠病 (IBD) 和减肥手术）之间可能存在的双向关系。事实上，一方面研究了这些疾病对维生素 D 状态的影响，另一方面也评估了维生素 D 缺乏症对这些疾病的病理生理学和临床过程的可能作用。所有检查的吸收不良疾病都会严重损害维生素 D 状态。由于维生素 D 对骨骼有已知的积极影响，这反过来可能导致骨骼不良后果，包括骨密度降低和骨折风险增加，而维生素 D 补充可能会减轻这种后果。由于免疫和代谢的骨骼外作用，维生素 D 水平较低可能会对潜在的胃肠道疾病产生负面影响，使其临床过程恶化或抵消治疗效果。因此，应该常规评估所有患有这些疾病的患者的维生素 D 状态并进行补充。这种概念得到了一种可能的双向关系的支持，通过这种关系，维生素 D 状态不良可能会对潜在疾病的临床过程产生负面影响。有足够的要素来估计所需的维生素 D 水平阈值，超过该阈值，这些疾病的骨骼可能会获得有利影响。另一方面，需要进行专门的对照临床试验，以更好地确定获得维生素 D 补充对吸收不良的胃肠道疾病发生和临床过程的积极影响的阈值。
