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IBD is widely recognized as a multifactorial condition. Previous research has linked melatonin to IBD owing to its secretion by enterochromaffin cells (EC). Gastrointestinal melatonin serves various functions in the intestine, including activation of membrane receptors such as MT2, modulation of serotonin receptors, regulation of sympathetic neurons, antioxidant properties, and modulation of inflammation. The current study aimed to assess melatonin-sulfate concentrations in spot urines from IBD patients in remission. We hypothesize that the levels of melatonin will be elevated at baseline in patients with IBD in remission due to a chronic inflammatory state.

This study was completed utilizing urine symptoms from a biorepository. In this investigation, a total of 29 spot urine samples were collected from IBD patients in remission (11 female/18 male; mean age 14.4, range 8-20 years; 5 UC/24 CD) and a control group consisting of 29 non-IBD patients (14 female/18 male; mean 14.6, range 8-20 years). Melatonin-sulfate urine enzyme-linked immunosorbent assay (ELISA) was conducted following the manufacturer's instructions (IBL International) to quantify melatonin levels. Melatonin-sulfate concentrations were compared between IBD patients and controls utilizing the Mann-Whitney U test and concentrations were assessed for correlation with ESR and CRP. The effect size was calculated using Cohen’s d.

Urinary melatonin-sulfate concentration was elevated in IBD patients as compared to controls (68.4 ± 142.81 vs. 35.41 ± 42.96; p<0.033). There was a medium effect size (Cohen’s d = .312). There was no correlation between melatonin-sulfate concentrations and either ESR or CRP in either group.

Spot urinary melatonin-sulfate is elevated in IBD patients, even in remission, and is unrelated to inflammatory markers in this group. This is the first study to assess spot urine melatonin-sulfate concentrations and suggests that IBD is associated with altered production and/or metabolism, even in remission. Whether this is reflective of asymptomatic low-grade inflammation is not clear. Although the current pilot study utilized a small sample size, it lays the groundwork for further research into the role for melatonin in the pathogenesis of IBD.

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Urinary Melatonin-sulfate in Pediatric Patients with Inflammatory Bowel Disease: A Pilot Study