小型研究指出饮食可改善IBD症状


  【24drs.com】在线发表于2016年12月27日临床肠胃病学期刊的一篇小型研究认为,单靠饮食即可让轻度到中度溃疡性结肠炎与克隆氏症的病童达到临床缓解。
  
  第一作者、华盛顿西雅图儿童医院David L. Suskind医师在医院新闻稿中表示,这改变了我们对于发炎性肠道疾病[IBD]儿童之治疗模式的选择。
  
  作者们指出,大多数(医学)中心通常使用类固醇或其它药物治疗,但是常伴随潜在的不良反应。
  
  为期12周的测试饮食称为「特殊碳水化合物饮食 (specific carbohydrate diet,SCD)」,它去除加工食品和糖(蜂蜜除外)、乳制品与谷物,它只纳入蔬菜、水果、肉类和坚果-富含营养的天然食物。
  
  全部共有12名患者(9人在西雅图、3人在亚特兰大或格鲁吉亚)在第2、4、8、12周经评估而开始SCD;饮食方式对2个患者无效,这2人无法维持这种饮食方式。
  
  作者们报告指出,在为期3个月的研究结束时,完成研究的10名10-17岁患者中的8人单靠饮食即达到缓解。
  
  研究结束时,这些孩童的平均儿科克隆氏症活性指数从28.1 ± 8.8降至4.6 ± 10.3,平均儿科溃疡性结肠炎活性指数从28.3 ± 23.1降至6.7 ± 11.6。
  
  12个月时,西雅图患者的平均C-反应蛋白质数值从24.1 ± 22.3降至7.1 ± 0.4 mg/L (正常值:<8.0 mg/L),亚特兰大的患者从20.7 ± 10.9降至4.8 ± 4.5 mg/L ((正常值:<4.9 mg/L)。
  
  这篇前瞻试验的患者是轻微到中度IBD,属于儿科克隆氏症活性指数10-45或儿科溃疡性结肠炎活性指数10-65。
  
  为了符合资格,患者在纳入研究前至少1个月未曾添加新的IBD免疫抑制剂药物,如果是生物制剂则是需要至少2个月。
  
  马里兰州巴尔的摩约翰霍普金斯大学Meyerhoff发炎性肠道疾病中心主任、医学教授Steven Brant医师表示,初步结果很有趣,但还不确定。
  
  他指出,该研究被设计为初步且检测安全性与潜在效益,应在此范畴内解释结果。该研究没有对照组、属于开放卷标型、且患者样本数很小;另外,2名患者因为无法维持这种饮食方式而退出。
  
  Brant医师表示,以严格的临床科学方式,你必须将这些视为失败,你必须假设这些人做得不好。另外,重点是要顾虑,持续参与研究的孩童有3个人体重减轻,这一点在孩童中需要特别关注。
  
  不过,原本的12名孩童依旧有8人达到缓解,相较于其它IBD治疗方式,这是令人印象深刻的。
  
  他指出,还不清楚任何新药对于结果有多少影响,而非饮食方式。Brant医师表示,虽然参与研究者在开始研究前1个月不能改变药物(比较强的药物则是2个月前),某些药物需要比较长的时间才会显示出效果。
  
  Brant医师表示,使用azathioprine这类属于研究前1个月应限制之药物的患者,可能服用了2-4个月才显示出效果,根据这篇研究,有2名患者服用此药。
  
  他指出,患者可能变得对他们的药物更加遵医嘱,因为它们是研究的一部份,且由医师定期检查。
  
  令人兴奋的事实是,C-反应蛋白质显著减少。
  
  他表示,这些是使我们前进的研究类型,证明进行大型研究采取下一步可能会是值得的。
  
  首先,重点在以更大型研究厘清这种饮食方式是否有效且与对照组比较,如果有,造成差异的因素是什么。
  
  此外,作者们报告指出,饮食帮助患者朝向更正常的微生物模式,这引起了鸡生蛋还是蛋生鸡的问题,Brant医师表示,是因为你的发炎症状改善而改变了菌丛,还是菌丛的变化改善了发炎症状?
  
  Brant医师表示,在他自己有尝试SCD的患者中,结果不一。采用这种饮食的患者有些能够停止免疫抑制治疗,大部份则否。有些人已经停药,但是后来不得不再度用药。
  
  他认为,对于[SCD]有极大兴趣,而对于遵守这项饮食方式,是很大的挑战。
  
  他更常推荐地中海式饮食,它几乎没有加工食品与单糖,且动物性蛋白大多是来自鱼类。
  
  作者们承认有一些研究限制,Suskind医师在新闻稿中表示,治疗的优先顺序将因人而异。
  
  他表示,SCD是我们帮助治疗这些患者的另一种工具,它可能不是每个人的最佳治疗选择,但是,对于那些希望尝试某种饮食疗法的人而言,它是一个有效的治疗。
  
  资料来源:http://www.24drs.com/
  
  Native link:IBD: Diet Improves Symptoms in Small Study

IBD: Diet Improves Symptoms in Small Study

By Marcia Frellick
Medscape Medical News

Diet alone can lead children with mild to moderate ulcerative colitis and Crohn's disease into clinical remission, suggests a small study published online December 27, 2016, in the Journal of Clinical Gastroenterology.

"This changes the paradigm for how we may choose to treat children with inflammatory bowel disease [IBD]," lead author David L. Suskind, MD, from Seattle Children's Hospital in Washington, said in a hospital news release.

Most centers typically treat with steroids or other medications, which come with potential adverse effects, the authors note.

Specific Carbohydrate Diet

The diet tested over the course of 12 weeks is called the specific carbohydrate diet (SCD), and it removes processed foods and sugars (except honey), dairy, and grains. It includes only vegetables, fruits, meats, and nuts — natural foods rich in nutrients.

At the end of the 3-month study, eight of the 10 patients, aged 10 to 17 years, who finished the study achieved remission from the diet alone, the authors report.

Twelve patients (nine in Seattle, and three in Atlanta, Georgia) started SCD with evaluations at 2, 4, 8, and 12 weeks.

By the end of the study, mean pediatric Crohn's disease activity index decreased from 28.1 ± 8.8 to 4.6 ± 10.3. Mean pediatric ulcerative colitis activity index dropped from 28.3 ± 23.1 to 6.7 ± 11.6.

The diet was not effective for two patients, and two were unable to maintain the diet. Mean C-reactive protein level dropped from 24.1 ± 22.3 to 7.1 ± 0.4 mg/L at 12 weeks in Seattle patients (normal, <8.0 mg/L) and decreased from 20.7 ± 10.9 to 4.8 ± 4.5 mg/L among the Atlanta patients (normal, <4.9 mg/L).

The patients in the prospective trial had mild to moderate IBD, determined either by a pediatric Crohn's disease activity index of between 10 and 45 or a pediatric ulcerative colitis activity index of between 10 and 65.

To be eligible, patients could not have started a new IBD medication for at least 1 month before the study for immunosuppressives and 2 months for biologics.

Unanswered Questions

Steven Brant, MD, professor of medicine and director of the Meyerhoff Inflammatory Bowel Disease Center at Johns Hopkins University in Baltimore, Maryland, said the initial results are interesting, but inconclusive.

He noted that the study was designed to be preliminary and to test safety and potential efficacy, and results should be interpreted as such. There was no control group, it was open label, and the patient size was very small.

In addition, two patients dropped out because they could not maintain the diet, he points out.

"In a strictly clinical science way, you have to look at those as failures...you have to assume those people would have done poorly," Dr Brant said. Also, he said, it is important to consider that three of the patients who remained in the study lost weight, a particular concern in children.

Still, eight of the original 12 children were in remission, and that is impressive compared with many other therapies for IBD, he said.

He added that it may be unclear how much effect any new medications, rather than the diet, might have on the outcomes. Although participants could not change medications for a month before the study (2 months for stronger medications), some drugs take longer than that to show effectiveness, Dr Brant said.

Among those is azathioprine, Dr Brant said, which would fall under the 1-month restriction in the study, but can take 2 to 4 months to show effectiveness. According to the study, two patients were taking that drug.

The patients may have also become more adherent to their medications because they were part of a study and would regularly be checked by a physician, he added.

"The exciting thing really was that there was a significant decrease in the C-reactive protein," he said.

These are the kinds of studies that move us forward and show that it may be worthwhile to take the next step in a large study, he said.

First, it is important to find out with larger studies whether this diet really does work compared with a control group, and if so, what part makes the difference, he said.

In addition, the authors report that the diet helped patients move toward a more normal microbial pattern, which raises a chicken-and-egg question, Dr Brant said: "Is it that you got improvement in the inflammation and then the bacteria changed, or did a change in the bacteria improve the inflammation?"

Dr Brant told Medscape Medical News that he has had mixed results among his own patients who have tried SCD. Whereas some patients on the diet have been able to move off immunosuppressive therapies, most have not. "Some have been able to come off but then have had to come on again," he said.

"I think there's great interest in [SCD]. I think it's a very big challenge to follow the diet," he said.

He more commonly recommends a Mediterranean-style diet with few processed foods and simple sugars and more fish than animal protein.

The authors acknowledge the limitations of the study, and Dr Suskind said in the news release that priorities for treatments will vary by the individual.

"SCD is another tool in our tool belt to help treat these patients. It may not be the best treatment option for everyone, but it is an effective treatment for those who wish to try a dietary therapy," he said.

The authors and Dr Brant have disclosed no relevant financial relationships.

J Clin Gastroenterol. Published online December 27, 2016.

    
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