Dietary Treatment of Crohn's Disease

描述（由申请人提供）：我们的长期目标是证明CAM技术可以改善炎症性肠病（ibd）的治疗，包括溃疡性结肠炎（UC）和克罗恩病（CD）。我们的直接目标是确定特定的饮食干预或低聚果糖（FOS）补充剂是否具有抗氧化或益生元作用，以及它是否有益于治疗乳糜泻。支持饮食与乳糜泻之间的紧密联系，补充和替代医学（CAM）文献中的一些流行病学研究和治疗观察表明，饮食是乳糜泻发展及其治疗的关键。我们利用这些CAM建议，设计了一种包含这些CAM系统共同建议的饮食，特别注意增加具有抗氧化和益生元作用的饮食食物的摄入量。我们的初步研究表明，将这种饮食与FOS补充剂一起使用，我们的饮食干预是可接受的，耐受性良好，66%的患者得到改善，症状和/或炎症程度减轻。这一发现现在需要通过一项更强有力的研究来验证，并且需要阐明饮食控制影响的潜在机制——比如对微生物群的潜在影响。在另一项利用扩增子长度异质性的初步研究中，我们证明了乳糜泻患者的肠道菌群与健康个体存在显著差异。然而，我们是否能使乳糜泻患者的菌群正常化仍有待确定。因此，我们设计了一项研究来验证以下假设：(1)饮食控制与饮食或FOS补充剂是一种有效的CAM疗法，可以防止CD复发（导致维持缓解）；(2)这种饮食控制可以使CD患者的微生物群正常化，减少粘膜氧化损伤。

DESCRIPTION (provided by applicant): Our long-term objective is to show that CAM techniques can improve management of inflammatory bowel disease (ibd) which includes Ulcerative Colitis (UC) and Crohn's Disease (CD). Our immediate objective is to determine whether a specific dietary intervention or a fructooligosaccharide (FOS) supplement has anti-oxidant or prebiotic effects and whether it is beneficial in the treatment of CD. Supporting a strong link between diet and CD, several epidemiological studies and therapeutic observations in the complementary and alternative medicine (CAM) literature suggest that diet is key to development of CD and its treatment. We took advantage of these CAM recommendations and designed a diet encompassing recommendations common to these CAM systems with particular attention to increasing the intake of dietary foodstuffs that have antioxidant and prebiotic effects. Using this diet together with a FOS supplement, our preliminary studies showed that our diet intervention is acceptable and well-tolerated and results in improvement of 66% of patients, reducing symptoms and/or the degree of inflammation. This finding now needs to be validated by a study with a stronger design, and the mechanisms underlying the effects of dietary manipulation-such as potential effects on microflora- need to be elucidated. In another pilot study using amplicon length heterogeneity, we demonstrated that the intestinal microflora of patients with CD differ significantly from healthy individuals. Whether we can normalize the microflora of CD patients, however, remains to be determined. Accordingly, we designed a study to test the hypotheses that: (1) dietary manipulation with either diet or a FOS supplement is an effective CAM therapy that prevents CD relapse (leads to maintenance of remission) and (2) such dietary manipulation can normalize the microflora of CD patients and decrease mucosal oxidative damage. Aim 1. To determine in a pilot, open-label study, whether dietary manipulation with a specific dietary therapy (that encompasses recommendations of various CAM practices) or a FOS supplement prevents flare-up in patients with inactive CD. Aim 2. To determine a) whether the same dietary manipulation with a specific dietary therapy or FOS normalizes colonic microflora and prevents mucosal oxidative damage in CD; and b) whether the observed changes correlate with clinical maintenance of remission. Significance. This study could provide information to suggest diet as a safe therapy for IBD and lay the groundwork for more definitive, randomized, controlled trials.