A novel uc exclusion diet and antibiotics for treatment of mild to moderate pediatric ulcerative colitis: A prospective open-label pilot study

Chen Sarbagili-Shabat, Lindsey Albenberg, Johan Van Limbergen, Naomi Pressman, Anthony Otley, Michal Yaakov, Eytan Wine, Dror Weiner, Arie Levine*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background: As the microbiome plays an important role in instigating inflammation in ulcerative colitis (UC), strategies targeting the microbiome may offer an alternative therapeutic approach. The goal of the pilot trial was to evaluate the potential efficacy and feasibility of a novel UC exclusion diet (UCED) for clinical remission, as well as the potential of sequential antibiotics for diet-refractory patients to achieve remission without steroids. Methods: This was a prospective, single-arm, multicenter, open-label pilot study in patients aged 8–19, with pediatric UC activity index (PUCAI) scores >10 on stable maintenance therapy. Patients failing to enter remission (PUCAI < 10) on the diet could receive a 14-day course of amoxycillin, metronidazole and doxycycline (AMD), and were re-assessed on day 21. The primary endpoint was intention-to-treat (ITT) remission at week 6, with UCED as the only intervention. Results: Twenty-four UCED treatment courses were given to 23 eligible children (mean age: 15.3 ± 2.9 years). The median PUCAI decreased from 35 (30–40) at baseline to 12.5 (5–30) at week 6 (p = 0.001). Clinical remission with UCED alone was achieved in 9/24 (37.5%). The median fecal calprotectin declined from 818 (630.0–1880.0) µg/g at baseline to 592.0 (140.7–1555.0) µg/g at week 6 (p > 0.05). Eight patients received treatment with antibiotics after failing on the diet; 4/8 (50.0%) subsequently entered remission 3 weeks later. Conclusion: The UCED appears to be effective and feasible for the induction of remission in children with mild to moderate UC. The sequential use of UCED followed by antibiotic therapy needs to be evaluated as a microbiome-targeted, steroid-sparing strategy.

Original languageEnglish
Article number3736
JournalNutrients
Volume13
Issue number11
DOIs
StatePublished - Nov 2021

Funding

FundersFunder number
Canada Research Chair Tier 2 in Translational Microbomics
Canadian Association of Gastroenterology—Crohn’s Colitis Canada
Solomon Foundation
Canadian Institutes of Health Research
Azrieli Foundation

    Keywords

    • Antibiotics
    • Child
    • Diet
    • Remission
    • Treatment
    • Ulcerative colitis

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