单纯饮食治疗缓解活动性炎性肠病儿童患者

　　炎性肠病是指影响消化道的几种相关疾病，主要包括两种形式：克罗恩病、溃疡性结肠炎。在大多数医院，炎性肠病治疗通常局限于非甾体类抗炎药物、免疫抑制剂或糖皮质激素类，通常会带来终身副作用。这些传统治疗可能抑制免疫系统，而不能治疗生活在消化道的微生物群。当个体遗传组成、免疫系统、微生物群之间发生紊乱时，就发生了炎性肠病。

　　2016年12月27日，世界胃肠病学组织官方期刊《临床胃肠病学杂志》在线发表美国华盛顿大学、西雅图儿童医院、亚特兰大儿童医院的研究报告，发现单纯饮食治疗可以缓解活动性克罗恩病和溃疡性结肠炎儿童患者的临床症状。

　　该小型前瞻研究给予12位10～17岁轻中度炎性肠病患者一种特定碳水化合物饮食12周，作为唯一干预治疗活动性克罗恩病或溃疡性结肠炎。特定碳水化合物饮食是一种营养均衡饮食，去掉了谷物、乳制品、加工食品和糖（蜂蜜除外），只提供天然、营养丰富的食物，包括蔬菜、水果、肉类和坚果。

　　结果发现，12周结束时，10位患者完成研究，其中8位有效。平均儿科克罗恩病活动指数（PCDAI）由28.1±8.8降至4.6±10.3，平均儿科溃疡性结肠炎活动指数（PUCAI）由28.3±23.1降至6.7±11.6。西雅图、亚特兰大患者的平均C-反应蛋白分别由24.1±22.3降至7.1±0.4mg/L（nL＜8.0mg/L）、由20.7±10.9降至4.8±4.5mg/L（nL＜4.9mg/L）。粪便微生物组分析显示，每个患者的大多数嗜碱性微生物存在特异性生态失调，在饮食变化后微生物组成发生显著变化。

　　因此，作者认为这将改变炎性肠病儿童的治疗模式。

　　截止目前为止，仅有几例全食物饮食（类似特定碳水化合物饮食）病例报告用于炎性肠病治疗。本研究首次证明这种饮食治疗炎性肠病儿童患者安全有效。

　　该研究表明，饮食对疾病是有影响的，而且可以有效影响。现有证据提示，饮食可使患者进入缓解期。

　　每一种疾病都是独一无二的，正如每个个体是唯一的，特定碳水化合物饮食是治疗这些患者的另一种工具，可能对每一个人未必都是最佳治疗，但是对于那些愿意尝试饮食治疗的患者是一种有效治疗。

J Clin Gastroenterol. 2016 Dec 27. [Epub ahead of print]

Clinical and Fecal Microbial Changes With Diet Therapy in Active Inflammatory Bowel Disease.

Suskind DL, Cohen SA, Brittnacher MJ, Wahbeh G, Lee D, Shaffer ML, Braly K, Hayden HS, Klein J, Gold B, Giefer M, Stallworth A, Miller SI.

Seattle Children's Hospital, University of Washington, Seattle, WA; Children's Healthcare of Atlanta, Atlanta, Georgia.

GOAL: To determine the effect of the specific carbohydrate diet (SCD) on active inflammatory bowel disease (IBD).

BACKGROUND: IBD is a chronic idiopathic inflammatory intestinal disorder associated with fecal dysbiosis. Diet is a potential therapeutic option for IBD based on the hypothesis that changing the fecal dysbiosis could decrease intestinal inflammation.

STUDY: Pediatric patients with mild to moderate IBD defined by pediatric Crohn's disease activity index (PCDAI 10-45) or pediatric ulcerative colitis activity index (PUCAI 10-65) were enrolled into a prospective study of the SCD. Patients started SCD with follow-up evaluations at 2, 4, 8, and 12 weeks. PCDAI/PUCAI, laboratory studies were assessed.

RESULTS: Twelve patients, ages 10 to 17 years, were enrolled. Mean PCDAI decreased from 28.1±8.8 to 4.6±10.3 at 12 weeks. Mean PUCAI decreased from 28.3±23.1 to 6.7±11.6 at 12 weeks. Dietary therapy was ineffective for 2 patients while 2 individuals were unable to maintain the diet. Mean C-reactive protein decreased from 24.1±22.3 to 7.1±0.4 mg/L at 12 weeks in Seattle Cohort (nL<8.0 mg/L) and decreased from 20.7±10.9 to 4.8±4.5 mg/L at 12 weeks in Atlanta Cohort (nL<4.9 mg/L). Stool microbiome analysis showed a distinctive dysbiosis for each individual in most prediet microbiomes with significant changes in microbial composition after dietary change.

CONCLUSIONS: SCD therapy in IBD is associated with clinical and laboratory improvements as well as concomitant changes in the fecal microbiome. Further prospective studies are required to fully assess the safety and efficacy of dietary therapy in patients with IBD.

PMID: 28030510

DOI: 10.1097/MCG.0000000000000772