Failure of Synbiotic 2000 to Prevent Postoperative Recurrence of Crohn’s Disease [Exclusion diet in Crohn disease: a controlled, randomized study]. Treatment of ulcerative colitis by feeding with germinated barley foodstuff: first report of a multicenter open control trial Application of the Montreal classification for Crohn's disease to a single clinician database of 1015 patients. Issues related to the conduct of systematic reviews: a focus on the nutrition field. Synbiotic therapy (Bifidobacterium longum/Synergy 1) initiates resolution of inflammation in patients with active ulcerative colitis: a randomised controlled pilot trial Effect of Dietary Inulin Supplementation on Inflammation of Pouch Mucosa in Patients With an Ileal Pouch-Anal Anastomosis Controlled multicentre therapeutic trial of an unrefined carbohydrate, fibre rich diet in Crohn's disease. Maintenance of remission in ulcerative colitis with sulphasalazine or a high-fibre diet: a clinical trial. Germinated barley foodstuff prolongs remission in patients with ulcerative colitis. CROHN'S DISEASE: MAINTENANCE OF REMISSION BY DIET Low residue or normal diet in Crohn's disease: a prospective controlled study in Italian patients. Randomized clinical trial of Plantago ovata seeds (dietary fiber) as compared with mesalamine in maintaining remission in ulcerative colitis. Spanish Group for the Study of Crohn's Disease and Ulcerative Colitis (GETECCU). Ispaghula husk may relieve gastrointestinal symptoms in ulcerative colitis in remission. Ingested matter affects intestinal lesions in Crohn's disease Beneficial Effects of Probiotic Bifidobacterium and Galacto-Oligosaccharide in Patients with Ulcerative Colitis: A Randomized Controlled Study
Complications of Crohn ’s disease ( CD ) lead to surgery in about 70–90 % of patients . The majority of patients suffer from relapse of the disease . Colonic bacteria are essential to the development of CD . Therefore , a rationale exists in trying to prevent relapse by manipulation of gut microflora . This is feasible by treatment with probiotics or antibiotics . Synbiotic 2000 is a cocktail containing 4 probiotic species and 4 prebiotics . It is rational to pursue that it could be effective in preventing postoperative disease . We sought to check weather treatment with Synbiotic 2000 could prevent postoperative recurrence in patients with CD . This was a prospect i ve multicenter , r and omized study . Patients were r and omized to active treatment or placebo in a 2:1 ratio . Follow-up consisted of endoscopic , clinical , and laboratory parameters . Thirty patients were enrolled . No differences were found between the 2 treatment groups regarding gender , age at diagnosis , age at surgery , weight , smoking status , type of disease , length of the resected segment , or medical treatment prior to surgery . No difference in either endoscopic or clinical relapse rate was found between patients treated with once daily dose of Synbiotic 2000 or placebo . In our small study , Synbiotic 2000 had no effect on postoperative recurrence of patients with CD . Larger studies in patients with the inflammatory type of CD undergoing surgery , using higher doses of probiotics cocktail might prove effective In a controlled study patients with Crohn 's disease received an exclusion diet or an diet low in refined carbohydrates and rich in fiber .  A total of 26 patients was observed for 1 year . The exclusion diet was not significantly superior to the st and ard diet with respect to the clinical course ( Crohn 's disease activity index according to Best or van Hees ) or laboratory parameters of inflammatory activity . During dietary counselling relapses were infrequent and symptoms improved in both dietary groups Background . Germinated barley foodstuff ( GBF ) is a prebiotic foodstuff that effectively increases luminal butyrate production by stimulating the growth of protective bacteria . In the first pilot study , GBF has been shown to reduce both clinical activity and mucosal inflammation in ulcerative colitis ( UC ) . The aim of this study was to investigate the efficacy of GBF in the treatment of UC in a multicenter open control trial . Methods . Eighteen patients with mildly to moderately active UC were divided into two groups using a r and om allocation protocol . The control group ( n = 7 ) were given a baseline anti-inflammatory therapy for 4 weeks . In the GBF-treated group ( n = 11 ) , patients received 20–30 g GBF daily , together with the baseline treatment , for 4 weeks . The response to the treatments was evaluated clinical ly and endoscopically . Fecal micro-flora were also analyzed . Results . After 4 weeks of observation , the GBF-treated group showed a significant decrease in clinical activity index scores compared with the control group ( P < 0.05 ) . No side effects related to GBF were observed . GBF therapy increased fecal concentrations of Bifidobacterium and Eubacterium limosum . Conclusions . Oral GBF therapy may have the potency to reduce clinical activity of UC . We believe that these results support the use of GBF administration as a new adjunct therapy for UC Crohn 's disease involves different gastrointestinal sites and may be characterized by high rates of strictures and penetrating complications . The present study applied the newly described Montreal schema of classification to a large , prospect ively accumulated clinical data base . In addition , age dependence was evaluated at diagnosis , with regard to disease location and disease behaviour . There were 1015 consecutively evaluated patients ( 449 male and 566 female ) . Disease was most often localized in the ileocolon and was usually complex with stricture formation or penetrating complications . For both sexes , with increasing age at diagnosis , Crohn 's disease was less extensive , more often localized in the colon alone and characterized by less complex disease behaviour , especially with less penetrating disease complications . Using the Montreal classification for Crohn 's disease , these results define the clinical features in a large , single clinician data base and demonstrate age dependence in the phenotypic clinical expression of Crohn 's disease Systematic review s ( SRs ) are an increasingly popular evidence -based tool and are often used to answer complex research questions across many different research domains . Early SR methodology was advanced by social scientists , and the term meta- analysis was coined by a social scientist who also conducted research in psychology . SRs have recently become popular in healthcare and are likely to be beneficial in any field . The aim of this report is to highlight issues in SR conduct with a focus on the field of nutrition and to make recommendations on improving SR conduct in this area . Development of the research question is probably the most important step in conducting an SR . The 4 main components of an answerable question are 1 ) the patient , population , or problem ; 2 ) the intervention , independent variable , or exposure ; 3 ) the comparators ; and 4 ) the dependent variables or outcomes of interest . The question will be used to determine the optimal methods for conducting the SR . SRs often include study design s beyond r and omized trials and do not always include a meta- analysis of the results . Other topics explored include underst and ing and interpreting discordant review s and the importance of reporting tools [ eg , QUality Of Reporting Of Meta-analyses ( QUOROM Statement ) or CONsoli date d St and ards Of Reporting of Trials ( CONSORT Statement ) ] . Recommendations are then provided , such as developing a capacity-building program , search ing the primary literature for research gaps , and extending reporting tools such as the QUOROM Statement to the field of nutrition Background and aims : Ulcerative colitis ( UC ) is an acute and chronic inflammatory disease of the large bowel with unknown aetiology . The immune response against normal commensal microorganisms is believed to drive inflammatory processes associated with UC . Therefore , modulation of bacterial communities on the gut mucosa , through the use of probiotics and prebiotics , may be used to modify the disease state . Methods : A synbiotic was developed for use in UC patients combining a probiotic , Bifidobacterium longum , isolated from healthy rectal epithelium , and a prebiotic ( Synergy 1 ) , a preferential inulin-oligofructose growth substrate for the probiotic strain . Treatment was employed in a double blinded r and omised controlled trial using 18 patients with active UC for a period of one month . Clinical status was scored and rectal biopsies were collected before and after treatment , and transcription levels of epithelium related immune markers were measured . Results : Sigmoidoscopy scores ( scale 0–6 ) were reduced in the test group ( start 4.5 ( 1.4 ) , end 3.1 ( 2.5 ) ) compared with placebo ( start 2.6 ( 2.1 ) , end 3.2 ( 2.2 ) ) ( p = 0.06 ) . mRNA levels for human beta defensins 2 , 3 , and 4 , which are strongly upregulated in active UC , were significantly reduced in the test group after treatment ( p = 0.016 , 0.038 , and 0.008 , respectively ) . Tumour necrosis factor α and interleukin 1α , which are inflammatory cytokines that drive inflammation and induce defensin expression , were also significantly reduced after treatment ( p = 0.018 and 0.023 , respectively ) . Biopsies in the test group had reduced inflammation and regeneration of epithelial tissue . Conclusions : Short term synbiotic treatment of active UC result ed in improvement of the full clinical appearance of chronic inflammation in patients receiving this therapy Abstract PURPOSE : Inflammation is a constant finding in the ileal reservoir of patients with an ileal pouch-anal anastomosis and is associated with decreased fecal concentrations of the short chain fatty acid butyrate , increased fecal pH , changes in fecal flora , and increased concentrations of secondary bile acids . In healthy subjects , inulin , a dietary fiber , is fermented to short chain fatty acids and leads to a lower pH and potentially beneficial changes in fecal flora . The aim of the present study was to investigate the effect of enteral supplementation of inulin on inflammation of the ileal reservoir . METHODS : Twenty patients received 24 g of inulin or placebo daily during three weeks in a r and omized , double-blind , crossover design . Stools were analyzed after each test period for pH , short chain fatty acids , microflora , and bile acids . Inflammation was assessed endoscopically , histologically , and clinical ly . RESULTS : Compared with placebo , three weeks of dietary supplementation with 24 g of inulin increased butyrate concentrations , lowered pH , decreased numbers of Bacteroides fragilis , and diminished concentrations of secondary bile acids in feces . This was endoscopically and histologically accompanied by a reduction of inflammation of the mucosa of the ileal reservoir . CONCLUSION : Enteral inulin supplementation leads to a decrease of inflammation-associated factors and to a reduction of inflammation of pouch mucosa Between 1 September 1980 and 31 August 1983 , 352 patients with inactive or mildly active Crohn 's disease but not taking drug treatment apart from sulphasalazine were entered from 40 hospitals into a prospect i ve trial to assess the effects of two different diets on disease activity over two years . One hundred and sixty two patients were r and omly allocated to take a diet unrestricted in sugar and low in fibre and 190 to a diet with little or no sugar and high in unrefined carbohydrate .  No clear difference in clinical course was detected among patients who accepted the two different types of dietary advice Twenty patients with ulcerative colitis in remission were asked to eat a high-fibre diet including 25 g bran daily and , if possible , to discontinue maintenance therapy with sulphasalazine . Only five patients ( 25 per cent ) were able to do this and remained in remission for six months . In contrast , of 15 patients asked to continue susphasalazine and their normal diet 12 ( 80 per cent ) remained in remission . A high-fibre diet is unable to replace sulphasalazine as maintenance treatment of ulcerative colitis in remission Germinated barley foodstuff ( GBF ) is a prebiotic which increases luminal butyrate production by modulating the microfloral distribution . GBF has been shown to reduce both clinical activity and mucosal damage in active ulcerative colitis ( UC ) with mild to moderate activity . However , the efficacy of GBF in patients with UC during the remission stage is unknown . The aim of this study was to investigate the efficacy of GBF as a maintenance therapy in patients with UC while in remission . Fifty-nine patients with UC in remission according to Rachmilewitz 's clinical activity index ( CAI ) score of < /=4 were enrolled and divided into two groups , control ( n=37 ) and GBF ( n=22 ) . Patients in the control group were given conventional treatment alone for 12 months , while patients in the GBF group received conventional therapy plus 20 g of GBF daily . The response to treatments was assessed by monitoring the CAI and endoscopic score according to Matts . Significantly better CAI values were seen in the GBF group at 3 , 6 , and 12 months compared with the values in the control group . The cumulative recurrence rate in the GBF group with steroid tapering treatment was significantly lower compared with the value in the control group . No side effects related to GBF were observed . GBF appeared to be effective and safe as a maintenance therapy to taper steroid dose and prolong remission in patients with UC 20 patients with Crohn 's disease took part in a controlled trial in which remission was maintained by either an unrefined carbohydrate fibre rich diet or a diet which excluded specific foods to which a patient was intolerant . 7 out of the 10 patients on the exclusion diet remained in remission for 6 months compared with none out of the 10 on an unrefined carbohydrate fibre rich diet ( p less than 0.05 , Fisher 's exact test ) . In an uncontrolled study an exclusion diet allowed 51 out of 77 patients to remain well on the diet alone for periods of up to 51 months , and with an average annual relapse rate of less than 10 % Seventy patients with non-stenosing Crohn 's disease were r and omly assigned to follow a low residue diet or a normal Italian diet for a mean of 29 months . The two groups were comparable at the onset in various measures of disease severity and diet . Patients complied well with the diet prescriptions , the low residue group eating a mean of 8.1 portions a week of fibre containing foods and the liberalized group a mean of 26.6 portions ( p less than 0.005 ) . There was no difference in outcome between the two groups , including symptoms , need for hospitalisation , need for surgery , new complications , nutritional status , or postoperative recurrence . Eighty six per cent of patients eating ad libitum and 65 % of patients who avoided roughage eliminated one or more permitted foods because of subjective intolerance . Lifting of dietary restrictions , which results in a more appetizing and nutritious diet , does not cause symptomatic deterioration or precipitate intestinal obstruction in Crohn 's disease OBJECTIVE Butyrate enemas may be effective in the treatment of active distal ulcerative colitis . Because colonic fermentation of Plantago ovata seeds ( dietary fiber ) yields butyrate , the aim of this study was to assess the efficacy and safety of Plantago ovata seeds as compared with mesalamine in maintaining remission in ulcerative colitis . METHODS An open label , parallel-group , multicenter , r and omized clinical trial was conducted . A total of 105 patients with ulcerative colitis who were in remission were r and omized into groups to receive oral treatment with Plantago ovata seeds ( 10 g b.i.d . ) , mesalamine ( 500 mg t.i.d . ) , and Plantago ovata seeds plus mesalamine at the same doses . The primary efficacy outcome was maintenance of remission for 12 months . RESULTS Of the 105 patients , 102 were included in the final analysis . After 12 months , treatment failure rate was 40 % ( 14 of 35 patients ) in the Plantago ovata seed group , 35 % ( 13 of 37 ) in the mesalamine group , and 30 % ( nine of 30 ) in the Plantago ovata plus mesalamine group . Probability of continued remission was similar ( Mantel-Cox test , p = 0.67 ; intent-to-treat analysis ) . Therapy effects remained unchanged after adjusting for potential confounding variables with a Cox 's proportional hazards survival analysis . Three patients were withdrawn because of the development of adverse events consisting of constipation and /or flatulence ( Plantago ovata seed group = 1 and Plantago ovata seed plus mesalamine group = 2 ) . A significant increase in fecal butyrate levels ( p = 0.018 ) was observed after Plantago ovata seed administration . CONCLUSIONS Plantago ovata seeds ( dietary fiber ) might be as effective as mesalamine to maintain remission in ulcerative colitis The efficiency of ispaghula husk in relieving gastrointestinal symptoms in patients with ulcerative colitis in remission was studied in a placebo-controlled trial running for 4 months . Twenty-nine patients ( 81 % ) completed the trial ; four withdrew after colitis relapse ( three while receiving placebo ) . Grading of symptoms judged ispaghula to be consistently superior to placebo ( p less than 0.001 ) and associated with a significantly higher rate of improvement ( 69 % ) than placebo ( 24 % ) ( p less than 0.001 ) . The results show that ispaghula can be helpful in the management of gastrointestinal symptoms in quiescent ulcerative colitis Background : Environmental factors of the modern Western lifestyle may trigger Crohn 's disease ( CD ) in susceptible individuals . Because such factors could be part of ingested matter , we intended to improve intestinal Crohn 's lesions by exclusion thereof . Methods : At first we tested a highly restricted diet ( based on spelt bread and red meat , both derived from intensively monitored organic farming ) in 5 pilot cases . In a subsequent controlled trial , 18 patients with mild‐to‐moderate CD were r and omly assigned to receive either this active diet or a control diet ( low‐fiber , low‐fat , and high‐carbohydrate ) .  Mucosal improvement was assessed by magnetic resonance imaging ( MRI ) and endoscopy . Secondary endpoints included sonography , the Crohn 's Disease Activity Index ( CDAI ) , and the Inflammatory Bowel Disease Question naire ( IBDQ ) . Results : Four of 5 pilot patients showed significant improvement within 4 weeks . From 18 patients in the controlled trial , 8 were r and omized to the active and 10 to the control group ; 4 decided to quit immediately after dietary counseling , 3 in the active and 1 in the control group ( P = 0.183 ) . At 6 weeks MRI and endoscopy showed improvement of intestinal lesions in 3 of 4 assessable patients of the active group and 1 of 9 patients of the control group ( P = 0.027 ) . Sonography showed improvement in 4 of 5 patients of the active group and in 1 of 8 assessable patients of the control group ( P = 0.016 ) . CDAI and IBDQ improved in both groups to a similar extent . Conclusions : Ingested matter as part of the modern Western lifestyle may cause persistence of intestinal Crohn 's lesions Background / Aim : In previous studies , we described the beneficial effects of bifidobacteria-fermented milk in patients with ulcerative colitis ( UC ) . Here , we examined the effects of a live Bifidobacterium breve strain Yakult , a probiotic contained in bifidobacteria-fermented milk , and galacto-oligosaccharide ( GOS ) as synbiotics in UC patients . Methods : Forty-one patients with mild to moderate UC were assigned to two groups ; one group was treated with the synbiotics and the other was not ( control ) . The treatment group ingested 1 g of the probiotic powder ( 109 CFU/g ) three times a day , and 5.5 g of GOS once a day for one year . At the start and the end of this study , colonoscopic index and the amount of myeloperoxidase in a lavage solution were used as disease activity indices . Bacterial counts in the feces at the start and the end of this study were also examined . Results : After a one-year treatment with the synbiotics , the clinical status of the UC patients as assessed by colonoscopy , significantly improved . Furthermore , the amount of myeloperoxidase in the lavage also decreased in these patients after the synbiotic treatment . The synbiotics significantly reduced the fecal counts of Bacteroidaceae and fecal pH. Conclusion : Administration of live B. breve strain Yakult and GOS can improve the clinical condition of patients with UC . These results encouraged us to perform a large-scale r and omized , placebo-controlled trial
BACKGROUND Dietary fiber may favorably influence fermentation , gastrointestinal inflammation , and disease progression in Crohn 's disease , ulcerative colitis ( UC ) , and pouchitis and offer an attractive therapeutic addition to pharmacological treatment .
This systematic review appraised data from r and omized controlled trials of fiber in the management of inflammatory bowel disease .