Division of Gastroenterology, Akita City Hospital, Akita City, Japan.
Perm J. 2021 Dec 8;25:21.052. doi: 10.7812/TPP/21.052.
We regard inflammatory bowel disease as a lifestyle disease mainly mediated by a westernized diet. We developed a plant-based diet (PBD) to counter the westernized diet. PBD can induce remission without medication in a subset of mild cases of ulcerative colitis. Medication is provided when induction of remission is not achieved solely with PBD. We describe such a case in this report.
A 34-year-old woman visited us in October 2016 with a complaint of loose stool for nearly 5 years. Laboratory examination revealed mild abnormalities including elevation of C-reactive protein (CRP). Ulcerative colitis was diagnosed due to diffuse colonic inflammation and pathological findings consistent with ulcerative colitis. She was admitted for educational hospitalization for 19 days in the middle of November, during which PBD was provided. A few days after admission, her stool became normal. CRP concentration decreased to within the normal range. However, colonoscopy on discharge showed minimum improvement. Thereafter, CRP was abnormal on three successive occasions, and her stool alternated between normal and loose. Sulfasalazine was initiated at the end of March 2017. Thereafter, her stool was normally formed, and CRP decreased to normal. Endoscopic remission was confirmed in August. Her PBD score, which evaluates adherence to PBD, was 8 before admission, and 37 and 16 at 7 and 21 months after discharge, respectively.
Medication was administered when restoration of a healthy dietary lifestyle was insufficient to induce remission. Our stepwise treatment makes the shift from one-size-fits-all medication toward medication to the right patient.
http://www.umin.ac.jp UMIN000019061.
我们认为炎症性肠病主要是由西式饮食引起的生活方式疾病。我们开发了一种植物性饮食（PBD）来对抗西式饮食。在轻度溃疡性结肠炎的一部分患者中，PBD 可以在无需药物的情况下诱导缓解。在诱导缓解不能仅通过 PBD 实现的情况下，提供药物。我们在本报告中描述了这样一个病例。
一位 34 岁女性因近 5 年大便松散来我院就诊。实验室检查显示轻度异常，包括 C-反应蛋白（CRP）升高。由于弥漫性结肠炎症和符合溃疡性结肠炎的病理发现，诊断为溃疡性结肠炎。她于 11 月中旬住院接受 19 天的教育性住院治疗，在此期间提供 PBD。入院几天后，她的大便正常，CRP 浓度降至正常范围内。然而，出院时的结肠镜检查显示最小改善。此后，CRP 连续 3 次异常，大便正常和松散交替。2017 年 3 月底开始使用柳氮磺胺吡啶。此后，她的大便正常形成，CRP 降至正常。8 月确认内镜缓解。她的 PBD 评分（评估对 PBD 的依从性）入院前为 8，出院后 7 个月和 21 个月分别为 37 和 16。
当恢复健康的饮食生活方式不足以诱导缓解时，给予药物治疗。我们的分步治疗使从一刀切的药物治疗转向针对正确患者的药物治疗。
http://www.umin.ac.jp UMIN000019061。
