Association of hyperhomocysteinemia and folate deficiency with colon tumors in patients with inflammatory bowel disease

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http://www3.interscience.wiley.com/cgi-bin/abstract/116331321/ABSTRACT?CRETRY=1 & SRETRY=0

Original Article

Association of hyperhomocysteinemia and folate deficiency with colon tumors in patients with inflammatory bowel disease

Jean Marc Phelip 1 *, Veronique Ducros 2, Jean Luc Faucheron 3, Bernard Flourie 4, Xavier Roblin 1

1Department of Gastroenterology, University Hospital of Grenoble, France2Department of Applied Biology, University Hospital of Grenoble, France3Department of Visceral Surgery, University Hospital of Grenoble, France4Department of Gastroenterology, University Hospital of Lyon, France

email: Jean Marc Phelip (JMPhelip@...)

*Correspondence to Jean Marc Phelip, Department of Gastroenterology, University Hospital of Grenoble, 38043 Grenoble BP217, France

Keywords

hyperhomocysteinemia • IBD • carcinogenesis

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 mol/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.

(Inflamm Bowel Dis 2007, Volume 14, Issue 2 , Pages 242 - 248)

Received: 12 July 2007; Accepted: 11 September 2007

Digital Object Identifier (DOI)10.1002/ibd.20309