Published online Jan 22, 2019. doi: 10.5409/wjcp.v8.i1.1
Peer-review started: October 8, 2018
First decision: November 7, 2018
Revised: December 31, 2018
Accepted: January 10, 2019
Article in press: January 10, 2019
Published online: January 22, 2019
Vitamin D deficiency is highly prevalent in children with inflammatory bowel disease (IBD). This may contribute to an increased risk of poor bone health and may also influence the course of disease. An optimal treatment strategy of vitamin D therapy in children with IBD has not yet been established.
To analyse the published intervention studies of vitamin D therapy in children with IBD.
A systematic review was conducted of clinical studies involving children with IBD (including Crohn disease or ulcerative colitis) who had received vitamin D therapy. Studies up to March 31st 2018 were identified through MEDLINE, PubMed, EMBASE and the Cochrane Library. Search terms included synonyms of the following terms: vitamin D, paediatric, supplementation, IBD. References of included articles based on abstract were searched for other relevant articles. All relevant articles were accessed and reviewed in full text. Studies fitting the set criteria were included and the remainder were excluded.
Two hundred and seventy-seven discrete articles were identified. Following assessment of these articles included in the initial search and application of inclusion and exclusion criteria, ten published studies were included in this review. The included studies showed a heterogeneity in study design, inclusion and exclusion criteria, baseline demographics and treatment strategies. Treatment regimens differed in length, supplemented form of vitamin D and factors based upon which dosage was adjusted. Each of the reports included in this review concluded their vitamin D regimens to be safe and well-tolerated. Few of the included studies reported secondary outcomes on the efficacy of vitamin D treatment upon the clinical course of disease or markers of inflammation. The majority of included trials were not sufficient in raising serum vitamin D levels to an adequate level (30 ng/mL) in children with IBD with vitamin D deficiency.
The included trials featured diverse treatment regimens that were predominantly insufficient in correcting vitamin D deficiency or maintaining adequate levels in children with IBD. Better treatment regimens are required for the management of vitamin D deficiency in children with IBD.
Core tip: Vitamin D deficiency is commonly seen in children diagnosed with inflammatory bowel disease (IBD). Correction of deficiency and optimisation of vitamin D levels likely contribute to enhanced bone health and possibly to the underlying disease course. The optimal regimen and target for vitamin D therapy are not yet elucidated. This systematic analysis aimed to review the available reports of vitamin D therapy in children with IBD to assess efficacy and safety of this treatment, address the diversity of the available trials and provide recommendations for future trials in this field on the basis of the evidence reviewed.