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Re: Influence of dietry factors on the clinical course of ulcerative colitis: a prospective cohort study

Dear Editor

Jowett and colleagues have recently reported in their elegant study, the role of diet to maintain remission in patients with ulcerative colitis.[1] Surely, the effect of diet has an essential, but often forgotten, role in altering the course of the disease in all types of inflammatory bowel diseases. This role does not necessarily act by maintaining patients in remission clinically, but perhaps more importantly by minimising the activities of the disease and rendering it quiescent.

We have recently reported a case of active stricturing Crohn’s disease in an adult female patient with high stoma output.[2] She was treated solely with casein-base formula (Modulen IBD-Nestle, Vevey, Switzerland) for 3 weeks. Her stoma output was reduced from 2,800 ml to 400 ml per day by day 10. The serum albumin and serum protein has significantly risen as well. She subjectively felt better and pain free and she stopped her opiate and non opiate formula. The casein-based formula is a nutritionally complete formulation containing a natural anti- inflammatory growth factor TGF-â2. The mechanism for inducing remission in our patient is possibly by inhibiting the expression of MHC class II protein to down-regulate the inflammatory response.[3]

Previous studies have shown that there is a decrease in the plasma anti-oxidant defences in all types of inflammatory bowel disease.[4] This is mirrored by increase in the free radical peripheral leukocyte DNA damage. It is therefore possible that casein-based formula acts as an anti-oxidant to minimise the oxidative stress that occurs in patients with active Crohn’s disease. The other possible mechanism is that this formula might have a role of a prebiotic by stimulating the activity of bacteria which is already present in the gut.

The remission induced in our case study highlights the part played by a casein-based formula in the management of adult Crohn’s disease. The encouraging result demonstrates the need to treat similar cases with dietary measures first. This opportunity should not be missed as it may well obviate the need for surgical intervention or administration of potent pharmacotherapy, which has the risk of several comorbidities.

References

(1) Jowett SL, Seal CJ, Pearce MS, Phillips E, Gregory W, Barton JR, Welfare MR. Influence of dietary factors on the clinical course of ulcerative colitis: a prospective cohort study. Gut 2004;53:1479-1484.

(2) S. Jones, H. Shannon, E. Srivastava, N Haboubi. A novel approach to a patient with Crohn’s disease and a high stoma output: a missed opportunity? Scand J Gastroenterol 2004, 4, 398 - 400

(3) Donnet-Hughes A, Duc N, Serrant P, Vidal K, Schiffrin EJ. Bioactive molecules in milk and their role in health and disease: the role of transforming growth factor-â. Immunol Cell Biol 2000;34:49-53