Terminal ileum resection is associated with higher plasma homocysteine levels in Crohn's disease

Background: Elevated plasma total homocysteine (tHcy) is associated with a higher risk of thrombosis. Crohn's disease (CD) is associated with hypercoa gulability of undefined etiology. We investigated tHcy in patients with CD and its relationship with vitamin status, disease activity, location, durat ion, and history of terminal ileum (TI) resection. Study: We examined fasti ng plasma tHcy, folate, serum vitamin B-12 levels, and sedimentation rate i n consecutive adult patients with CD. Harvey-Bradshaw index of CD activity and history of TI resection and thromboembolism were recorded. Results: Med ian plasma tHcy was 10.2 mu mol/L in 125 patients with CD. Men (n = 60) had higher plasma tHcy than women (n = 65) (11.2 vs. 9.1 mu mol/L; p = 0.004). Patients with a history of TI resection showed lower serum B-12 levels (29 3 vs. 503 pg/mL; p < 0.001) and higher plasma tHcy levels (11.0 vs. 9.35 mu mol/L; p = 0.027) than patients without such history. Multivariate analysi s showed history of TI resection, serum B-12, and creatinine levels to be s ignificant predictors of elevated plasma tHcy. Fourteen patients with CD wi th a history of thrombosis had an elevated median plasma tHcy of 11.6 mu mo l/L. Conclusions: Terminal ileum resection contributes to elevated plasma t Hcy levels in CD cases. We recommend tHcy screening in patients with CD, es pecially in those with prior history of TI resection, and the initiation of vitamin supplementation when appropriate.