Interesting paper on success of SCD therapy for children with IBD

[ebarker2]

http://pulse.seattlechildrens.org/n...sease-and-ulcerative-colitis-reach-remission/

 

[my little penguin]

Patients with CD or UC ages 8 to 21 with mild or moderate disease activity as defined by pediatric Crohn’s disease activity index (PCDAI) score of 10 to 45 or pedia- tric ulcerative colitis index (PUCAI) of 10 to 60 were enrolled into this study. Before the study no change in medication(s) for IBD could occur for a minimum of 1 month for immunosuppressive medications and 2 months for biologics.

From
http://pdfs.journals.lww.com/jcge/9...7mJu9kHaFpAcM8=;hash|IyXhMPL1i8ovFE8FHjk8Ow==


Full paper


These kids were not treated with DIET ALONE

They were permitted to have started it be on standard ibd
Meds such as immunosuppressants and biologics

So if they started immunosuppressants before this for two months and didn't change the dose month three could have started to work
Same with biologics they just could change the dose for two months on biologics
We all know biologics sometimes take a bit longer to work
Especially in kids


Very disappointed with how this setting is was presented as being DIET ONLY
Not DIET PLUS SOME REALLY STRONG DRUGS

Add in size of the study
Not statistically significant you need at least 25 participants

Twelve individuals (9 from Seattle Children’s and 3 from Children’s Center for Digestive Health Care, Atlanta, Georgia) enrolled in the study. Mean age of participants was 12.8 ± 2.2 years (range, 10 to 17 y). Six were male. Average disease duration before study was 1.3 ± 1.6 years (range, 0 to 5 y). For patients with CD, macroscopic disease at time of diagnosis per Paris classification was ileocolonic (L3) in 4 patients, ileal (L1) in 4 patients, and colonic (L2) in 1 patient. For patients with UC disease was extensive in 1 patient and pancolitis was present in 2 patients. At the time of entrance into the study, patients were on methotrexate (n=1), azathioprine (n=2), mesalamine (n=4), adali- mumab (n=1), ustekinumab (n=1), and no medication (n = 5)24 (Table 1).

So basically 5 kids without medicine - REALLY ONLY 5 kids

Four individuals had increased calprotectin at 12 weeks as compared with their 4-week level. The increase in mean calprotectin in the Atlanta group was largely driven by a single patient whose baseline calprotectin rose over 300 points from baseline. One individual confirmed eating non- SCD foods for 2 weeks before calprotectin. The other individual who had clinically performed quite well and maintained on the diet after the study had a normal repeat calprotectin 1 month after the study. The changes in cal- protectin for both the Seattle and Atlanta cohorts were not clinically significant (P = 0.10, 0.67, respectively).

So FOUR of the 12 had increase caloprotectin but they discount those .

Although the results of the study suggest an overall benefit for patients on the SCD with the majority of patients going into clinical remission and many showing an alteration of the microbiome, there are limitations to this study. As an open-labeled study, recruited patients and parents had a strong personal belief that SCD would improve symptoms. It cannot be excluded that participant bias could account for some of the effect seen in the PCDAI/PUCAI. The degree of mucosal healing in this study was not assessed with ileocolonoscopy, but objective evaluation of inflam- mation with both CRP and fecal calprotectin did support the improvements seen in clinical disease activity. Another limitation to dietary therapy is the difficulty in ascertaining compliance with the diet. Although we had study partic- ipants meet with a dietitian at each visit to review the diet, there are no objective measures of dietary compliance. Also, variations in treatment from the different study sites, interpretation of dietary protocols and local resources, could potentially impact the results of the study. Finally the small sample size for this study limits the precision of estimated effects of the SCD within our IBD patients. The study itself also highlights some of the difficulty of dietary therapy. Two individuals were unable to finish the study given difficulty maintaining the diet. In addition, although most individuals gained weight, some did not.

Some EVEN LOST WEIGHT

So basically
Diet can be an ADJUNCTIVE THERAPY in ADDITION to medicine

IF you base you decision on ALL 10 kids who finished the study
And TAKE AWAY the 4 kids WHO HAD INCREASE FECAL CAL
so really 6 whole Kids WHO IMPROVED on SCD diet

Even those they didn't say WHO LOST WEIGHT .

 

[my little penguin]

If you read more

With respect to sedimentation rate, of those individ- uals who were able to maintain the diet for the full study, baseline sedimentation rate was elevated in 5 of 10 patients, and by 12 weeks only 2 individuals had continued elevation of sedimentation rate (Table 3). The mean sedimentation rate decreased from 15.3 ± 11.0 mm/h at baseline to 11.0 ± 9.6 mm/h at the 2-week visit in the Seattle cohort (normal sedimentation rate, 0 to 20mm/h) and decreased from 35.7 ± 1.2 mm/h at baseline to 26.7 ± 16.6 mm/h at the 2-week visit in the Atlanta cohort (normal sed- imentation rate, 0 to 32 mm/h). At 8 and 12 weeks the mean sedimentation rate still remained below baseline level at 8.3 ± 6.0 and 7.4 ± 5.5 mm/h in the Seattle Cohort and 11.7 ± 6.4 and 12.0 ± 12.7 mm/h, respectively, in the Atlanta Cohort. Although there were decreases of sed- imentation rate in both the Seattle and Atlanta groups, only Atlanta changes in sedimentation rate are statistically sig- nificant (P=0.047 at 2wk; P<0.001 at 8 and 12wk).
Serum albumin improved or was maintained for all except 1 patient. Three of 4 patients who presented with hypoalbuminemia had normal of albumin levels by the end of the study (Table 3). The mean albumin levels increased from 4.1±0.77g/dL at baseline to 4.4±0.44g/dL at the 12-week visit in the Seattle cohort (normal albumin, 3.8 to 5.4 g/dL) and increased from 3.2 ± 0.76 g/dL at baseline

So out of 5 patients with high sed rate(ESR ) only 2 had increased Sed rate
3 out of the 5 decreased
Really a 60% improved vs 40 % who didn't
This is WHY YOU need more than 5 kids to test

From
Same paper

http://pdfs.journals.lww.com/jcge/9...7mJu9kHaFpAcM8=;hash|IyXhMPL1i8ovFE8FHjk8Ow==




Clinical and Fecal Microbial Changes With Diet Therapy in Active Inflammatory Bowel Disease
David L. Suskind, MD,* Stanley A. Cohen, MD,w
Mitchell J. Brittnacher, PhD,z Ghassan Wahbeh, MD,* Dale Lee, MD,* Michele L. Shaffer, PhD,*y Kimberly Braly, RD,* Hillary S. Hayden, PhD,z Jani Klein, BA,* Benjamin Gold, MD,w Matthew Giefer, MD,* Angela Stallworth, RD,w and Samuel I. Miller, MDz8z#**