The effect of a prebiotic with a probiotic on symptoms and quality of life in ulcerative colitis

The medical management of ulcerative colitis in children often requires aggressive pharmacological therapy or colonic resection. We hypothesized that synbiotic therapy, consisting of B. longum R0175 and inulin would improve symptoms and quality of life (QOL) in children diagnosed with ulcerative colitis. Consenting pediatric subjects (8-18 years; n = 9) with ulcerative colitis in remission were provided synbiotic therapy, (Probiotic: Bifidobacterium longum R0175 2.0 x 1010 cfu/day; Prebiotic: 15 g/day of inulin) (n = 4) or placebo (maltodextrin + ascorbic acid capsule; 15 g/day of non-resistant maltodextrin) (n = 5) for ten months in a pilot study (Phase I). After ten months, the study was unblinded and synbiotic therapy was administered to eight pediatric subjects (Phase II). In attempt to increase sample size, three adult subjects with active UC were recruited and provided the synbiotic therapy (Phase III). In all phases of the research, QOL was measured using the Short Inflammatory Bowel Disease Questionnaire (SIBDQ). The SIBDQ was administered at baseline and every two months. Subjects kept a daily records of symptoms (stool consistency and frequency, presence of blood and mucous, presence of abdominal pain and overall feeling). Phase I QOL scores were significantly better for those receiving the synbiotic therapy versus the placebo (p = 0.014). Severe symptoms occurred in 60% of the control subjects, where as subjects receiving synbiotic therapy did not experience severe symptoms (p = 0.032). Phase II QOL scores were significantly better post-treatment with synbiotic therapy (p=0.034). One subject (steroid dependant) was able to wean off Prednisone® while receiving the synbiotic therapy; she remained in remission and was symptom free for over 26 months. In Phase III, synbiotic therapy did not induce remission in the adult subjects with active UC. No adverse effects were reported.Synbiotic therapy consisting of Bifidobacterium longum R0175 and inulin, when provided in addition to conventional treatment, appears to be a safe and effective strategy for managing pediatric ulcerative colitis in remission.Further clinical trials are warranted to confirm these preliminary results

The Mediterranean diet pattern as a therapeutic approach for colitis

There is growing appreciation that the interaction between diet, the gut microbiota and the immune system contribute to the development and progression of chronic diseases like inflammatory bowel disease (IBD). Various types of dietary fat, independent of total fat content, uniquely influence intestinal inflammation, metabolism, and host-microbe dynamics. The Mediterranean Diet Pattern (MDP) is a health-promoting diet containing approximately 40% total fat. It is unknown if the blend of fats found in the MDP contributes to its beneficial health effects or could benefit patients living with ulcerative colitis (UC). For the experimental study, mice deficient in the mucin 2 gene (muc2-/-) were weaned to 40% fat, isocaloric, and isonitrogenous diets. We sought to clarify the effects of the MD fat blend on colitis by studying dietary fats in isolation from each other and a combination like the blend found in the MDP. We compared the MD fat blend (high monounsaturated fatty acids (MUFA), 2:1 n-6:n-3 polyunsaturated fatty acids (PUFA) and moderate saturated fat acids (SFA)) to diets composed of corn oil (CO, n-6 PUFA), olive oil (OO, high MUFA) or milk fat (MF, SFA) on spontaneous colitis development in Muc2-/- mice. The MD resulted in lower clinical and histopathological scores and induced tolerogenic CD103+CD11b+ dendritic cells, Th22 and IL-17+IL-22+ cells necessary for intestinal barrier repair. The MD was associated with beneficial microbes, and higher cecal acetic acid levels negatively correlated with colitogenic microbes like Akkermansia muciniphila. In contrast, CO showed a higher prevalence of mucin-degraders, including A. muciniphila and Enterobacteriaceae, which have been associated with colitis. For the clinical study, adult patients with quiescent UC were randomized to follow a MDP or Canadian habitual diet (CHD) for 12 weeks. The MDP resulted in reduced disease activity, symptoms, and inflammation-related biomarkers. Food components (fibre, dairy, olive oil and plant-based foods) commonly consumed in a MDP were positively associated with bacteria that produce metabolites related to health (Ruminococcus bromii, Flavonifractor plautii and Lactococcus lactis). Our findings suggest that the MDP could be utilized as adjunctive therapy to manage UC.Science, Irving K. Barber Faculty of (Okanagan)Biology, Department of (Okanagan)Graduat

An Examination of Diet for the Maintenance of Remission in Inflammatory Bowel Disease

Diet has been speculated to be a factor in the pathogenesis of inflammatory bowel disease and may be an important factor in managing disease symptoms. Patients manipulate their diet in attempt to control symptoms, often leading to the adoption of inappropriately restrictive diets, which places them at risk for nutritional complications. Health professionals struggle to provide evidence-based nutrition guidance to patients due to an overall lack of uniformity or clarity amongst research studies. Well-designed diet studies are urgently needed to create an enhanced understanding of the role diet plays in the management of inflammatory bowel disease. The aim of this review is to summarize the current data available on dietary management of inflammatory bowel disease and to demonstrate that dietary modulation may be an important consideration in managing disease. By addressing the relevance of diet in inflammatory bowel disease, health professionals are able to better support patients and collaborate with dietitians to improve nutrition therapy.Arts and Sciences, Irving K. Barber School of (Okanagan)Biology, Department of (Okanagan)ReviewedFacult

User testing to modify the MyHealthyGut digital health application for inflammatory bowel disease

Introduction Inflammatory bowel disease, characterized by chronic intestinal inflammation, can be subcategorized into Crohn's disease and ulcerative colitis. The treatment for these conditions is unique to each patient and may include lifestyle changes, pharmaceutical intervention, and surgery. Lifestyle changes, such as dietary intervention, are a cornerstone of inflammatory bowel disease symptom management. Given the daily burden of this disease, self-management is paramount in coping with and/or minimizing symptoms. The MyHealthyGut application, successfully proven to be a self-management tool for celiac disease, shows promise for use in an inflammatory bowel disease patient population. Objective To conduct user testing to gather valuable insights for the development of an IBD-focused version of the existing MyHealthyGut app. Methods Participants included inflammatory bowel disease patients and healthcare practitioners. Participants used the application for a 2-week period, followed by participation in a focus group or individual interview to provide feedback. Qualitative questionnaires were administered verbally and feedback was recorded. Thematic analysis techniques were used for data quantification and analysis. Results 15 participants were recruited and enrolled. Of these, 14 participants took part in the focus group and/or individual interviews. The feedback suggested changes related to clinical uses, food and symptom tracking, ease of use, and educational content. All (100%) participants reported that they would either use the application themselves or recommend it to patients, once their suggestions were implemented. Conclusion Through user testing and feedback collection, priorities for app modification were identified. Areas for modification in the app functions and features, ease of use, and content were identified. Once updated to meet the needs of inflammatory bowel disease patients, the MyHealthyGut app may be a useful tool for IBD self-management

Weighted Gene Co-Expression Network Analysis Identifies a Functional Guild and Metabolite Cluster Mediating the Relationship between Mucosal Inflammation and Adherence to the Mediterranean Diet in Ulcerative Colitis

Diet influences the pathogenesis and clinical course of inflammatory bowel disease (IBD). The Mediterranean diet (MD) is linked to reductions in inflammatory biomarkers and alterations in microbial taxa and metabolites associated with health. We aimed to identify features of the gut microbiome that mediate the relationship between the MD and fecal calprotectin (FCP) in ulcerative colitis (UC). Weighted gene co-expression network analysis (WGCNA) was used to identify modules of co-abundant microbial taxa and metabolites correlated with the MD and FCP. The features considered were gut microbial taxa, serum metabolites, dietary components, short-chain fatty acid and bile acid profiles in participants that experienced an increase (n = 13) or decrease in FCP (n = 16) over eight weeks. WGCNA revealed ten modules containing sixteen key features that acted as key mediators between the MD and FCP. Three taxa (Faecalibacterium prausnitzii, Dorea longicatena, Roseburia inulinivorans) and a cluster of four metabolites (benzyl alcohol, 3-hydroxyphenylacetate, 3-4-hydroxyphenylacetate and phenylacetate) demonstrated a strong mediating effect (ACME: −1.23, p = 0.004). This study identified a novel association between diet, inflammation and the gut microbiome, providing new insights into the underlying mechanisms of how a MD may influence IBD. See clinicaltrials.gov (NCT04474561)