Intest Res.  2022 Jan;20(1):78-89. 10.5217/ir.2020.00124.

Effectiveness of administering zinc acetate hydrate to patients with inflammatory bowel disease and zinc deficiency: a retrospective observational two-center study

• Sakurai K
• Furukawa S
• Katsurada T
• Otagiri S
• Yamanashi K
• Nagashima K
• Onishi R
• Yagisawa K
• Nishimura H
• Ito T
• Maemoto A
• Sakamoto N

• KMID: 2525075
• DOI: http://doi.org/10.5217/ir.2020.00124

Abstract

Background/Aims
Inflammatory bowel disease (IBD) patients frequently have zinc deficiency. IBD patients with zinc deficiency have higher risks of IBD-related hospitalization, complications, and requiring surgery. This study aimed to examine the effectiveness of zinc acetate hydrate (ZAH; Nobelzin) in IBD patients with zinc deficiency.
Methods
IBD patients with zinc deficiency who received ZAH from March 2017 to April 2020 were registered in this two-center, retrospective, observational study. Changes in serum zinc levels and disease activity (Crohn’s Disease Activity Index [CDAI]) before and after ZAH administration were analyzed.
Results
Fifty-one patients with Crohn’s disease (CD, n = 40) or ulcerative colitis (UC, n = 11) were registered. Median serum zinc level and median CDAI scores significantly improved (55.5–91.0 μg/dL, P< 0.001; 171.5–129, P< 0.001, respectively) in CD patients 4 weeks after starting ZAH administration. Similarly, median serum zinc levels and CDAI scores significantly improved (57.0–81.0 μg/dL, P< 0.001; 177–148, P= 0.012, respectively) 20 weeks after starting ZAH administration. Similar investigations were conducted in groups where no treatment change, other than ZAH administration, was implemented; significant improvements were observed in both serum zinc level and CDAI scores. Median serum zinc levels in UC patients 4 weeks after starting ZAH administration significantly improved from 63.0 to 94.0 μg/dL (P= 0.002), but no significant changes in disease activity were observed. One patient experienced side effects of abdominal discomfort and nausea.
Conclusions
ZAH administration is effective in improving zinc deficiency and may contribute to improving disease activity in IBD.

Keyword

Inflammatory bowel diseases; Zinc deficiency; Ulcerative colitis; Crohn disease; Zinc acetate

Figure

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  Fig. 1. Patient enrollment. Of the 56 inflammatory bowel disease (IBD) patients who were administered zinc acetate hydrate (ZAH) for zinc deficiency from March 2017 to April 2020, patients who self-interrupted administration, changed hospitals, or underwent total colectomy for ulcerative colitis (UC) were excluded; a total of 51 patients were included. Of these, analyses were conducted on 32 Crohn’s disease (CD) patients and 9 UC patients whose serum zinc levels were measured 4 weeks after ZAH administration, and 25 CD patients and 5 UC patients whose serum zinc levels were measured 20 weeks after ZAH administration.

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  Fig. 2. Changes in serum zinc levels and Crohn’s Disease Activity Index (CDAI) scores in Crohn’s disease (CD) patients before zinc acetate hydrate (ZAH) administration and 4 weeks or 20 weeks after administration. (A, B) The serum zinc levels of 32 CD patients were measured 4 weeks after ZAH administration. Median serum zinc levels significantly improved from 55.5 μg/dL (31–74) to 91.0 μg/dL (43–171) (P<0.001). Median CDAI scores significantly improved from 171.5 (43–546) to 129 (36–397) (P<0.001). (C, D) There were 25 CD patients whose serum zinc levels were measured 20 weeks after ZAH administration. Median serum zinc levels significantly improved from 57.0 μg/dL (31–73) to 81.0 μg/dL (58–189) (P<0.001). Median CDAI scores significantly improved from 177 (43–546) to 148 (36–397) (P=0.012).

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  Fig. 3. Changes in serum zinc levels and Crohn’s Disease Activity Index (CDAI) scores before and after zinc acetate hydrate (ZAH) administration in Crohn’s disease (CD) patients, in whom changes in treatment other than ZAH were not implemented from 4 weeks before to 4 weeks or 20 weeks after starting ZAH administration. (A, B) A total of 81.3% (26/32) of the CD patients did not undergo changes in treatment other than ZAH from 4 weeks before to 4 weeks after starting ZAH administration. The median serum zinc levels significantly improved from 57.0 μg/dL (31–74) to 91.0 μg/dL (43–171) (P<0.001). Median CDAI scores significantly improved from 145 (43–546) to 116 (36–397) (P=0.003). (C, D) A total of 76.0% (19/25) of CD patients did not undergo changes in treatment other than ZAH from 4 weeks before to 20 weeks after starting ZAH administration. The median serum zinc levels significantly improved from 59.0 μg/dL (46–73) to 85.0 μg/dL (58–189) (P<0.001). Median CDAI scores significantly improved from 170 (21–430) to 109 (21–425) (P=0.004).

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  Fig. 4. Correlation between serum zinc level and Crohn’s Disease Activity Index (CDAI) score or C-reactive protein (CRP) in Crohn’s disease (CD) patients. (A, B) Before zinc acetate hydrate (ZAH) administration, there was a moderate correlation between serum zinc level and CDAI score (r=–0.439, P=0.005), and there was a moderate correlation between serum zinc level and CRP (r=–0.483, P=0.002). (C, D) Four weeks after ZAH administration, there was no correlation between the degree of increase in serum zinc level and the degree of improvement in CDAI score (r=–0.020, P=0.913), and there was no correlation between the degree of increase in serum zinc level and the degree of improvement in CRP (r=–0.047, P=0.800). (E, F) Twenty weeks after ZAH administration, there was no correlation between the degree of increase in serum zinc level and the degree of improvement in CDAI score (r=–0.301, P=0.148), and there was no correlation between the degree of increase in serum zinc level and the degree of improvement in CRP (r=–0.090, P=0.668).

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  Fig. 5. Changes in serum zinc level and partial Mayo score in ulcerative colitis (UC) patients before zinc acetate hydrate (ZAH) administration and 4 weeks or 20 weeks after administration. (A, B) There were 9 UC patients whose serum zinc levels were measured 4 weeks after ZAH administration. Median serum zinc levels significantly improved from 63.0 μg/dL (57–74) to 94.0 μg/dL (53–146) (P=0.020). Median partial Mayo scores improved from 3 (0–9) to 1 (0–4) (P=0.125). (C, D) There were 5 UC patients whose serum zinc levels were measured 20 weeks after ZAH administration. Median serum zinc levels significantly improved from 63.0 μg/dL (57–73) to 94.0 μg/dL (62–109) (P=0.125). Median partial Mayo scores before and after ZAH administration improved from 3 (0-5) to 1 (0-3) (P=0.688).

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