Diet and Complementary Therapy Among Patients With IBD

While diet changes and complementary therapy will not cure the disease, alternative therapies may help control symptoms, ease pain, improve mood and general attitude and contribute to a better quality of life, a panel including Gil Melmed, MD, David Rubin, MD, James Lewis, MD, Kelly Issokson, MS, and Oriana Damas, MD, said at the Advances in Inflammatory Bowel Disease annual meeting in Orlando, Florida, on December 14.

Dr Melmed is a professor of medicine and director of IBD Clinical Research at F Widjadja IBD Institute at Cedars-Sinai Medical Center in Los Angeles, California. Dr Rubin is the Joseph B. Kirsner professor of medicine and chief of the section of gastroenterology, hepatology, and nutrition at the University of Chicago. Dr Lewis is a professor of medicine and epidemiology at the University of Pennsylvania. Ms Issokson is a registered dietitian who specializes in GI diseases and disorders. Dr Damas is an internal medicine specialist and a gastroenterologist at the University of Miami Health Sytem.

To treat moderate-to-severe ulcerative colitis (UC), Dr Melmed said the addition of phytochemical compound curcumin to mesalamine therapy was reported to be effective in maintaining remission in patients with UC.

Indigo naturalis, a traditional Chinese medicine, when administered 0.5-2.0 grams per day for 8 weeks, was also found to be effective in inducing a clinical response in patients with UC. However, the panel agreed, both these alternative medications had a potential for adverse effects, including pulmonary arterial hypertension, intussusception, abnormal liver enzymes, and headaches.

A systematic review and meta-analysis to examine the efficacy of probiotics in IBD published in Alimentary Pharmacology and Therapeutics revealed that probiotics with 5-aminosalicylates were effective in preventing relapse of quiescent UC. However, the efficacy of probiotics in CD remains uncertain and needs more studies.

The panel explored various dietary therapies among patients with IBD. They compared exclusive enteral nutrition (EEN) to the Crohn’s disease exclusion diet (CDED), which is a whole-food diet coupled with partial enteral nutrition (PEN). CDED is designed “to reduce exposure to dietary components that have adverse effects on the microbiome and intestinal barrier.”

Among children with mild to moderate CD, CDED plus PEN was better tolerated than EEN. “While both diets were effective in inducing remission by week 6 among 74 patients (mean age 14.2), the combination diet induced sustained remission in a significantly higher proportion of patients and produced changes in the fecal microbiome associated with remission,” they explained.

Lastly, the experts shed light on clinical trials of cannabis and cannabinoid derivatives. Cannabis has shown slight reduction in CDAI in 4 out of 5 trials for CD, and reduction in Lichtiger index in both the trials for UC. However, “there is still no significant evidence that summarizes the efficacy and safety of cannabis for IBD,” they concluded.

Reference:

Melmed G. Clinical breakout session: Diet and complementary therapy. Presented at: Advances in Inflammatory Bowel Disease annual meeting; December 14, 2023. Orlando, Florida.