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Infrequency of colonization with Oxalobacter formigenes in inflammatory bowel disease: Possible role in renal stone formation
Author(s) -
KUMAR RITU,
GHOSHAL UDAY C,
SINGH GUNJANA,
MITTAL RAMA D
Publication year - 2004
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/j.1440-1746.2004.03510.x
Subject(s) - medicine , ulcerative colitis , inflammatory bowel disease , gastroenterology , oxalate , urinary system , calcium oxalate , creatinine , uric acid , disease , chemistry , organic chemistry
Background and Aim: Calcium oxalate renal stones (RS) and hyperoxaluria are common in patients with inflammatory bowel disease (IBD). The absence of intestinal oxalate degrading bacteria, Oxalobacter formigenes , may cause hyperoxaluria in IBD. The aim of the present study was to examine: (i) the colonization of O. formigenes in patients with IBD and controls and to correlate its presence with urinary oxalate excretion; and (ii) urinary analytes contributing to RS in IBD. Methods: Stool samples were studied for O. formigenes using polymerase chain reaction and Southern blotting in patients with IBD ( n = 48: ulcerative colitis, 37; Crohn's disease, 11), RS ( n = 87) and healthy subjects that were used as controls ( n = 48). Levels of urinary oxalate, citrate, calcium, magnesium, creatinine and uric acid were estimated spectrophotometrically in each patient and in 13 controls for 24 h. Results: Five of the 48 (10.4%) patients with IBD had RS. Five of the 48 (10.4%) patients with IBD, 25 of the 87 (29%) with RS and 27 of the 48 (56%) controls were colonized with O. formigenes ( P < 0.001 for RS vs controls and P = 0.01 for RS vs IBD). Patients without O. formigenes had higher urinary oxalate than those with it (IBD, median 0.48 [range 0.11–2.09] vs 0.43 [range 0.16–1.10] mmol/24 h, P = NS; RS, median 0.59 mmol/24 h, range 0.14–1.90 vs 0.44 mmol/24 h, range 0.23–0.97; P = 0.008, Mann–Whitney U ‐test). Median excretion of oxalate was higher in IBD and RS than in controls (0.47 [0.11–2.09], 0.56 [0.14–1.9] and 0.41 [0.21–0.62] mmol/24 h; P < 0.01), respectively. Median calcium was also higher in IBD and RS than in controls (6.50 [1.38–21.00], 6.78 [1.55–20.30] and 4.99 [1.47–9.60] mmol/24 h; P < 0.05, Kruskal–Wallis H ‐test), respectively. Median urinary magnesium was higher in IBD than in RS and controls (4.57 [1.50–12.30], 3.60 [0.90–6.35] and 2.49 [0.74–4.80]; P < 0.001, Kruskal–Wallis H ‐test), respectively. Urinary citrate excretion was comparable in IBD, RS and controls. Conclusions: Patients with IBD and RS rarely have O. formigenes in their stools as compared with controls; this may contribute to hyperoxaluria in IBD. Hyperoxaluria and hypercalciuria may contribute to RS in patients with IBD. Hypermagnesuria in patients with IBD may protect them from RS.