Role of sulphasalazine in the aetiology of folate deficiency in ulcerative colitis.

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Abstract
Only 2 (2.5%) of 80 outpatients with histologically proven ulcerative colitis had folate deficiency associated with anemia or macrocytosis. Mean folate absorption, measured using 3 .mu.g/kg body wt of a 3H-labeled physiological folate derivative, 5-methyltetrahydroteroylglutamic acid, in 6 newly diagnosed patients was 76.7% (normal > 95%), but fell to 69.4% after 3 mo. treatment with sulfasalazine. Mean difference in individual patients was 7.5% .+-. 5.2% (SD) (P < 0.02). Mean folate absorption in 4 patients with megaloblastic anemia or macrocytosis, which developed during treatment with sulfasalazine, was 66.3%. This rose to 82.4% after the drug was stopped. Mean difference in individual patients was 16.6 .+-. 6.6% (SD) (P < 0.001). All patients who developed anemia or macrocytosis with sulfasalazine had additional reasons for folate deficiency. These included coliac disease, severe nutritional deficiencies and hemolysis. Sulfasalazine impaired folate absorption but this only became significant if other reasons for folate deficiency were also present.