小型研究指出飲食可改善IBD症狀


  【24drs.com】線上發表於2016年12月27日臨床腸胃病學期刊的一篇小型研究認為,單靠飲食即可讓輕度到中度潰瘍性結腸炎與克隆氏症的病童達到臨床緩解。
  
  第一作者、華盛頓西雅圖兒童醫院David L. Suskind醫師在醫院新聞稿中表示,這改變了我們對於發炎性腸道疾病[IBD]兒童之治療模式的選擇。
  
  作者們指出,大多數(醫學)中心通常使用類固醇或其他藥物治療,但是常伴隨潛在的不良反應。
  
  為期12週的測試飲食稱為「特殊碳水化合物飲食 (specific carbohydrate diet,SCD)」,它去除加工食品和糖(蜂蜜除外)、乳製品與穀物,它只納入蔬菜、水果、肉類和堅果-富含營養的天然食物。
  
  全部共有12名患者(9人在西雅圖、3人在亞特蘭大或喬治亞)在第2、4、8、12週經評估而開始SCD;飲食方式對2個患者無效,這2人無法維持這種飲食方式。
  
  作者們報告指出,在為期3個月的研究結束時,完成研究的10名10-17歲患者中的8人單靠飲食即達到緩解。
  
  研究結束時,這些孩童的平均兒科克隆氏症活性指數從28.1 ± 8.8降至4.6 ± 10.3,平均兒科潰瘍性結腸炎活性指數從28.3 ± 23.1降至6.7 ± 11.6。
  
  12個月時,西雅圖患者的平均C-反應蛋白質數值從24.1 ± 22.3降至7.1 ± 0.4 mg/L (正常值:<8.0 mg/L),亞特蘭大的患者從20.7 ± 10.9降至4.8 ± 4.5 mg/L ((正常值:<4.9 mg/L)。
  
  這篇前瞻試驗的患者是輕微到中度IBD,屬於兒科克隆氏症活性指數10-45或兒科潰瘍性結腸炎活性指數10-65。
  
  為了符合資格,患者在納入研究前至少1個月未曾添加新的IBD免疫抑制劑藥物,如果是生物製劑則是需要至少2個月。
  
  馬里蘭州巴爾的摩約翰霍普金斯大學Meyerhoff發炎性腸道疾病中心主任、醫學教授Steven Brant醫師表示,初步結果很有趣,但還不確定。
  
  他指出,該研究被設計為初步且檢測安全性與潛在效益,應在此範疇內解釋結果。該研究沒有對照組、屬於開放標籤型、且患者樣本數很小;另外,2名患者因為無法維持這種飲食方式而退出。
  
  Brant醫師表示,以嚴格的臨床科學方式,你必須將這些視為失敗,你必須假設這些人做得不好。另外,重點是要顧慮,持續參與研究的孩童有3個人體重減輕,這一點在孩童中需要特別關注。
  
  不過,原本的12名孩童依舊有8人達到緩解,相較於其他IBD治療方式,這是令人印象深刻的。
  
  他指出,還不清楚任何新藥對於結果有多少影響,而非飲食方式。Brant醫師表示,雖然參與研究者在開始研究前1個月不能改變藥物(比較強的藥物則是2個月前),某些藥物需要比較長的時間才會顯示出效果。
  
  Brant醫師表示,使用azathioprine這類屬於研究前1個月應限制之藥物的患者,可能服用了2-4個月才顯示出效果,根據這篇研究,有2名患者服用此藥。
  
  他指出,患者可能變得對他們的藥物更加遵醫囑,因為它們是研究的一部份,且由醫師定期檢查。
  
  令人興奮的事實是,C-反應蛋白質顯著減少。
  
  他表示,這些是使我們前進的研究類型,證明進行大型研究採取下一步可能會是值得的。
  
  首先,重點在以更大型研究釐清這種飲食方式是否有效且與對照組比較,如果有,造成差異的因素是什麼。
  
  此外,作者們報告指出,飲食幫助患者朝向更正常的微生物模式,這引起了雞生蛋還是蛋生雞的問題,Brant醫師表示,是因為你的發炎症狀改善而改變了菌叢,還是菌叢的變化改善了發炎症狀?
  
  Brant醫師表示,在他自己有嘗試SCD的患者中,結果不一。採用這種飲食的患者有些能夠停止免疫抑制治療,大部份則否。有些人已經停藥,但是後來不得不再度用藥。
  
  他認為,對於[SCD]有極大興趣,而對於遵守這項飲食方式,是很大的挑戰。
  
  他更常推薦地中海式飲食,它幾乎沒有加工食品與單糖,且動物性蛋白大多是來自魚類。
  
  作者們承認有一些研究限制,Suskind醫師在新聞稿中表示,治療的優先順序將因人而異。
  
  他表示,SCD是我們幫助治療這些患者的另一種工具,它可能不是每個人的最佳治療選擇,但是,對於那些希望嘗試某種飲食療法的人而言,它是一個有效的治療。
  
  資料來源: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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