*Division of Gastroenterology, Scripps Clinic, La Jolla, California; †Scripps Translational Science Institute, La Jolla, California; ‡Division of Cardiology, Scripps Clinic, La Jolla, California; §Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; ‖School of Exercise and Nutritional Sciences, San Diego State University, San Diego, California; and ¶Department of Integrative Structural and Computational Biology, The Scripps Research Institute, La Jolla, California.
Inflamm Bowel Dis. 2017 Nov;23(11):2054-2060. doi: 10.1097/MIB.0000000000001221.
Data suggest dietary modification can improve clinical responses in inflammatory bowel disease (IBD). The goal of this study was to determine the efficacy of an autoimmune protocol diet in patients with Crohn's disease and ulcerative colitis.
We enrolled adults with active IBD (Harvey-Bradshaw index ≥ 5 or partial Mayo score ≥3 and erosions on endoscopy and/or elevated fecal calprotectin). For the autoimmune protocol, patients underwent 6-week elimination followed by 5-week maintenance phase. Clinical indices, laboratories, and biomarkers were assessed at baseline and weeks 6 and 11. Endoscopy was performed at study completion.
The final cohort included 15 patients with IBD, with mean disease duration 19 years (SD 14.6) and active biological use in 7 (47%) patients. Nutrient repletion was initiated for deficiencies in vitamin D (n = 3) and iron (n = 6). From week 0 to weeks 6 and 11, mean partial Mayo score significantly improved from 5.8 (SD 1.2) to 1.2 (SD 2.0) and 1.0 (SD 2.0) for ulcerative colitis, and mean Harvey-Bradshaw index significantly improved from 7 (SD 1.5) to 3.6 (SD 2.1) and 3.4 (SD 2.6) for Crohn's disease. C-reactive protein did not significantly change during study. Mean fecal calprotectin improved from 471 (SD 562) to 112 (SD 104) at week 11 (P = 0.12). Among those with follow-up endoscopy at week 11 (n = 7), improvements were noted in simple endoscopic score for Crohn's disease (n = 1), Rutgeerts score (n = 1), and Mayo endoscopy subscore (n = 4).
Dietary elimination can improve symptoms and endoscopic inflammation in patients with IBD. Randomized controlled trials are warranted.
有数据表明，饮食调整可以改善炎症性肠病（IBD）患者的临床反应。本研究的目的是确定克罗恩病和溃疡性结肠炎患者采用自身免疫协议饮食的疗效。
我们招募了患有活动期 IBD（Harvey-Bradshaw 指数≥5 或部分 Mayo 评分≥3 且内镜下有糜烂和/或粪便钙卫蛋白升高）的成年人。对于自身免疫协议，患者进行 6 周的排除期，然后进入 5 周的维持期。在基线、第 6 周和第 11 周评估临床指标、实验室和生物标志物。在研究完成时进行内镜检查。
最终队列包括 15 名 IBD 患者，平均疾病持续时间为 19 年（SD 14.6），7 名（47%）患者正在使用生物制剂。因维生素 D（n=3）和铁（n=6）缺乏而开始补充营养。从第 0 周到第 6 周和第 11 周，溃疡性结肠炎的部分 Mayo 评分从 5.8（SD 1.2）显著改善至 1.2（SD 2.0）和 1.0（SD 2.0），克罗恩病的 Harvey-Bradshaw 指数从 7（SD 1.5）显著改善至 3.6（SD 2.1）和 3.4（SD 2.6）。研究期间 C 反应蛋白没有明显变化。粪便钙卫蛋白在第 11 周时从 471（SD 562）降至 112（SD 104）（P=0.12）。在第 11 周进行了内镜随访的 7 名患者中，克罗恩病的简单内镜评分（n=1）、Rutgeerts 评分（n=1）和 Mayo 内镜亚评分（n=4）均有改善。
饮食排除可改善 IBD 患者的症状和内镜下炎症。需要进行随机对照试验。
