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P492 The UC Diet and Antibiotics for Treatment of Mild to Moderate Pediatric Ulcerative Colitis: A prospective open label pilot study

Sarbagili Shabat, C.(1,2);Albenberg, L.(3);Van Limbergen, J.(4,5);Otley, A.(6);Yaakov, M.(1);Wine, E.(7);Weiner, D.(1);Levine, A.(1,2);

(1)Edith Wolfson Medical Center, PIBD Research center- Paediatric Gastroenterology and Nutrition Unit, Holon, Israel;(2)Tel-Aviv University, The Sackler Faculty of Medicine, Tel-Aviv, Israel;(3)Children’s Hospital of Philadelphia, Division of Gastroenterology- Hepatology- and Nutrition, Philadelphia- Pennsylvania, United States;(4)Amsterdam University Medical Centers, Emma Children’s Hospital, Amsterdam, The Netherlands;(5)University of Amsterdam, Tytgat Institute for Liver and Intestinal Research- Amsterdam Gastroenterology and Metabolism- Academic Medical Center, Amsterdam, The Netherlands;(6)IWK Health Center, Division of Gastroenterology and Nutrition, Halifax, Canada;(7)University of Alberta, Departments of Pediatrics and Physiology, Edmonton- Alberta, Canada

Background

Strategies that target the microbiome may offer an alternative therapeutic approach for Ulcerative Colitis (UC). The goal of the pilot trial was to evaluate the efficacy of a novel microbe-directed UC diet (UCD) for clinical remission, as well as use of antibiotics for dietary refractory patients as an alternative strategy for remission.

Methods

This was a prospective, single arm, open label, pilot study in patients aged 8-19, with a pediatric UC activity index (PUCAI) scores >10 on stable maintenance therapy. Patients failing to enter remission (PUCAI<10) on 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 UCD.

Results

Twenty-four UCD treatment courses were given to 23 eligible children (mean age 15.3±2.9 years). Median PUCAI decreased from baseline 35 (30-40) to 12.5 (5-27.5) week 6 (P=0.001). Clinical remission with UCD alone was achieved in 9/24 (37.5%). Median calprotectin declined from baseline 818 (630.0-1880.0) to 592.0 (140.7-902.4) week 6. Eight patients received treatment with antibiotics after failing diet, 4/8 (50.0%) subsequently entered remission 3 weeks later.

Conclusion

The UC Diet appears to be effective for induction of remission in children with mild to moderate UC suggesting that diet could play a role in the disease. Sequential use of UCD followed by antibiotic therapy needs to be evaluated as a microbiome targeted steroid sparing strategy.

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