Introduction Vitamin D (vit D) deficiency is a common consequence of short bowel syndrome and can detrimentally affect bone and muscle health. Oral vit D supplements can be absorbed variably and parenteral supplementation does not always result in improved serum levels.¹ We wished to see if buccal vit D supplementation represents a useful alternative?

Methods Patients with short bowel syndrome who had not responded to high dose oral vit D supplementation and were prescribed buccal vit D spray (“Dlux3000” BetterYou^(TM)) were identified through the regional nutrition service (n = 13). This cohort was 46.2% female and 53.8% male with a mean age of 52.7 years. Accurate measurements of all participants small bowel functionality were not available, however, 7 were recorded as having less than 100 cm of small bowel remaining. Not all participants were reliant on parenteral nutrition (n = 7), those who were(n = 6) received between 10 and 15 L parenteral nutrition per week. Participants were prescribed between 3000 and 9000 iu/day. 25(OH) vit D was used to measure vit D status. Baseline levels were obtained prior to when buccal vit D was prescribed. This was compared with the level obtained at their next clinic appointment, at least one month later. For analysis a paired t test was undertaken in two groups; A, including (n = 13), and B excluding (n = 8), patients using other vitamin D supplements concurrently. Of those in group B 75% had previously been prescribed oral vit D supplements without achieving vit D sufficiency.

Results Group A: Mean baseline 25(OH)D was 22.3 ng/ml, 95%CI (18.1,26.5) (. Buccal vit D supplementation increased this to an average of 61.4 ng/ml, 95%CI (44.7, 78.1). This increase proved to be statistically significant (p =< 0.05) and suggests that buccal vit D either alone or as an adjunct to oral supplements produces a significant rise in vit D level from that of deficiency to sufficiency.

Group B: Mean baseline 25(OH)D was 21.9 ng/ml, 95%CI (18.3, 25.4). Using buccal vit D spray alone mean 25(OH)D was increased to 53 ng/ml, 95%CI (43.2, 62.8) (p =< 0.05). This suggests that buccal vit D monotherapy may be sufficient to achieve adequate vit D levels in those patients who have not responded to oral supplements.

Conclusion This study provides preliminary evidence from a small number of patients that buccal vit D spray may be an effective adjunct to oral vit D supplementation or be an effective monotherapy in short bowel patients who do not respond adequately to oral supplements. Further investigation into buccal vit D spray is warranted.

Reference 1 Thacher TD, Clarke BL. Vitamin D insufficiency. Mayo Clin Proc 2011;86(1):50–60. http://doi.org/ 10.4065/mcp.2010.0567

Disclosure of Interest G. Thomson: None Declared, C. Mountford: None Declared, N. Thompson Conflict with: BSG secretary