CHICAGO — Ten patients with moderate Crohn's disease took supplements of fructooligosaccharide, a substance found in artichokes and asparagus, and showed an increase in fecal Bifidobacteria and production of mucosal dendritic cells, James Lindsay, Ph.D. said at the annual Digestive Disease Week.
Although the findings are preliminary, this is the first known study of “prebiotic” dietary therapies for Crohn's, and the strategy may offer a way to supplement traditional treatments or to manage patients who do not respond to them, he said.
Fructooligosaccharide is a carbohydrate that selectively alters the colonic microbiota, Dr. Lindsay explained. It is a prebiotic that may provide a substrate upon which healthy bacteria can grow, as opposed to probiotics, which are the healthy bacteria themselves.
The supplement given to the 10 patients in the open-label study was prepared by Nestlé UK, which provided financial support for the research. The patients took 15 g per day for 3 weeks.
Patients and doctors noted an improvement on the Harvey Bradshaw index, with the mean falling from 9.8 at the start of the study to 6.9 at the end. Remission of Crohn's disease was achieved by 40% of the patients. There was a 6.8% increase in the volume of Bifidobacteria found in dried fecal samples between the start and end of the study. In addition, the number of interleukin-10 dentridic cells increased, as did the number of cells expressing Toll-like receptors.
Patients in the study, 60% of whom were completely compliant with the study regimen, tolerated the supplement well. The most common complaints were rumbling and flatulence.
“Traditional therapies tend to increase effector pathways. The alternative is to increase regulatory pathways,” said Dr. Lindsay, consultant gastroenterologist at St Bartholomew's Hospital and the Royal London Hospital.
Balfour Sartor, M.D., a professor of medicine, microbiology, and immunology at the University of North Carolina at Chapel Hill, is familiar with the work of Dr. Lindsay and his colleagues because it overlaps with his own.
He said that Dr. Lindsay's study is not in the mainstream of Crohn's research, but that it is a legitimate area of investigation.
“The normal bacteria in the gut are probably the dominant antigenic stimulus driving immune mediation,” he said. “Altering the diet is a natural way of doing things that is presumed to have less toxicity and be less costly,” he said.
Dr. Lindsay emphasized the preliminary nature of the findings.