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Clinical and Fecal Microbial Changes With Diet Therapy in Active Inflammatory Bowel Disease

Suskind, David L. MD*; Cohen, Stanley A. MD; Brittnacher, Mitchell J. PhD; Wahbeh, Ghassan MD*; Lee, Dale MD*; Shaffer, Michele L. PhD*,§; Braly, Kimberly RD*; Hayden, Hillary S. PhD; Klein, Jani BA*; Gold, Benjamin MD; Giefer, Matthew MD*; Stallworth, Angela RD; Miller, Samuel I. MD‡,∥,¶,#,**

Journal of Clinical Gastroenterology: February 2018 - Volume 52 - Issue 2 - p 155–163
doi: 10.1097/MCG.0000000000000772
ALIMENTARY TRACT: Original Articles

Goal: To determine the effect of the specific carbohydrate diet (SCD) on active inflammatory bowel disease (IBD).

Background: IBD is a chronic idiopathic inflammatory intestinal disorder associated with fecal dysbiosis. Diet is a potential therapeutic option for IBD based on the hypothesis that changing the fecal dysbiosis could decrease intestinal inflammation.

Study: Pediatric patients with mild to moderate IBD defined by pediatric Crohn’s disease activity index (PCDAI 10-45) or pediatric ulcerative colitis activity index (PUCAI 10-65) were enrolled into a prospective study of the SCD. Patients started SCD with follow-up evaluations at 2, 4, 8, and 12 weeks. PCDAI/PUCAI, laboratory studies were assessed.

Results: Twelve patients, ages 10 to 17 years, were enrolled. Mean PCDAI decreased from 28.1±8.8 to 4.6±10.3 at 12 weeks. Mean PUCAI decreased from 28.3±23.1 to 6.7±11.6 at 12 weeks. Dietary therapy was ineffective for 2 patients while 2 individuals were unable to maintain the diet. Mean C-reactive protein decreased from 24.1±22.3 to 7.1±0.4 mg/L at 12 weeks in Seattle Cohort (nL<8.0 mg/L) and decreased from 20.7±10.9 to 4.8±4.5 mg/L at 12 weeks in Atlanta Cohort (nL<4.9 mg/L). Stool microbiome analysis showed a distinctive dysbiosis for each individual in most prediet microbiomes with significant changes in microbial composition after dietary change.

Conclusions: SCD therapy in IBD is associated with clinical and laboratory improvements as well as concomitant changes in the fecal microbiome. Further prospective studies are required to fully assess the safety and efficacy of dietary therapy in patients with IBD.

Supplemental Digital Content is available in the text.

*Department of Pediatrics, Division of Gastroenterology, Seattle Children’s Hospital and University of Washington

§Center for Clinical and Translational Research, Seattle Children’s Research Institute

Departments of Microbiology

Laboratory Medicine

Medicine

#Immunology

**Genome Sciences, University of Washington, Seattle, WA

Children’s Center for Digestive Health Care, and Children’s Healthcare of Atlanta, Atlanta, Georgia

Supported by grants from the Keating Foundation, Woodward Crohn’s and Colitis Foundation and Seattle Children’s Center for Clinical and Translational Research Academic Enrichment Fund. This publication was also supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR000423. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

D.L.S. has written a patient handbook on nutrition in IBD, Nutrition in Immune Balance. The other authors declare that they have nothing to disclose.

Address correspondence to: David L. Suskind, MD, Seattle Children’s Hospital, 4800 Sandpoint Way NE, Seattle, WA 98105 (e-mail: david.suskind@seattlechildrens.org).

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0/

Received July 7, 2016

Accepted November 4, 2016

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.