Dietary Treatment of Crohn's Disease

描述(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菌作用，以及它是否对治疗CD有益。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，饮食是发展CD及其治疗的关键，这支持了饮食与CD之间的密切联系。我们利用了这些CAM建议，并设计了一种包含这些CAM系统通用建议的饮食，特别注意增加具有抗氧化剂和益生菌作用的饮食食物的摄入量。使用这种饮食和FOS补充剂，我们的初步研究表明，我们的饮食干预是可接受的和耐受性良好的，结果改善了66%的患者，减轻了症状和/或炎症程度。这一发现现在需要通过一项更强有力的设计的研究来验证，而饮食操纵影响的潜在机制--例如对微生物区系的潜在影响--需要阐明。在另一项使用扩增片段长度异质性的先导性研究中，我们证明了CD患者的肠道微生物区系与健康人显著不同。然而，我们是否能使CD患者的微生物区系正常化仍有待确定。因此，我们设计了一项研究来检验以下假设：(1)饮食或补充FOS是预防CD复发(导致缓解)的有效CAM疗法，以及(2)这种饮食操作可以使CD患者的微生物区系正常化，减少粘膜氧化损伤。 目的1.在一项试验性的开放标签研究中，确定特定饮食疗法(包括各种CAM实践的建议)或FOS补充剂的饮食控制是否可以防止非活动性CD患者的发作。目的2.确定a)采用特定饮食疗法或低聚果糖的相同饮食疗法是否能使结肠微生物群正常化，并防止CD的粘膜氧化损伤；b)所观察到的变化是否与临床缓解的维持有关。意义重大。这项研究可以提供信息，建议饮食作为一种安全的IBD治疗方法，并为更明确的、随机的、对照试验奠定基础。

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.