Study shows diet has ‘underappreciated role’ in treating ulcerative colitis
Patients with ulcerative colitis following a novel diet achieved higher clinical remission and mucosal healing compared with patients who received a single donor fecal transplantation, with or without diet, according to a study.
“We evaluated whether integration of novel diets for donors and patients in addition to fecal transplantation (FT) could increase FT remission rate in refractory UC,” Chen Sarbagili Shabat, of the pediatric gastroenterology unit at Wolfson Medical Center’s PIBD Research Center in Holon, Israel, and colleagues wrote.
“UCED alone appeared to achieve higher clinical remission and mucosal healing than single donor FT with or without diet,” the researchers said. “The study was stopped for futility by a safety monitoring board.”
The blinded, randomized, controlled trial included 51 patients (mean age, 40.4 years [standard deviation, 12.5]; 27.5% women) with active UC. Patients were randomly assigned to one of three groups. Group 1 (n = 17) received a free diet and single donor FT by colonoscopy on day 1 and rectal enemas on days 2 and 14 without dietary conditioning of the donor. Group 2 (n = 19) received FT with dietary pre-conditioning of the donor for 14 days and an UCED for the patients. Group 3 (n = 15) received UCED alone. Week 8 clinical steroid free remission served as the primary endpoint.
Results at week 8 showed endoscopic remission was highest in group 3 at 26.6%. The lowest endoscopic remission was in group 1 (11.7%; P = .38). Investigators noted three patients (20%) in group 3 achieved mucosal healing (Mayo endoscopic score, 0) compared with zero patients who received FT (P = .022).
According to researchers, disease exacerbation occurred in three patients (17.6%) in group 1, four patients (21.1%) in group 2 and one patient (6.7%) in group 3.
“We suggest that one of the most important take home messages from this trial is that diet may have an underappreciated role in the treatment of UC and that further studies are required,” the researchers wrote.
“The UCED is currently being investigated in a randomized controlled trial. Finally, portraying worsening of disease along with response rates with therapy might help clinicians to better interpret data from clinical trials with FT.”