A prospective pilot study of a gluten‐free diet for primary sclerosing cholangitis and associated colitis

Abstract

Background: Primary sclerosing cholangitis (PSC) is a progressive bile duct disease associated with inflammatory bowel disease (PSC-IBD).Aim: To investigate whether patients with PSC-IBD benefit from a gluten-free and amylase trypsin inhibitor (ATI)-free diet (GFD). Methods:We performed a prospective clinical pilot study administering an eightweek GFD. The primary outcomes were colonic inflammation assessed by proctosigmoidoscopy, and liver stiffness (surrogate for fibrosis, inflammation and cholestasis) measured by transient elastography before and after GFD. Amongst the secondary (exploratory) outcomes were colonic mucosal and serum cytokine/chemokine changes, the intestinal microbiome and transcriptome dynamics, and shifts in serum markers of hepatic fibrogenesis.Results: Fifteen patients with PSC-IBD completed the study. The study did not meet its primary outcome: the endoscopic score and liver stiffness remained unchanged.However, the expression of pro-inflammatory mucosal cytokines and chemokines such as IL6, IL8, CCL2, and TNFα was significantly down-regulated. Two critical markers of liver fibrosis and matrix remodelling, thrombospondin-2 and -4, decreased significantly. The microbiota composition changed slightly, including a decrease in the pathogen Romboutsia ilealis. The intestinal transcriptome indicated a gut barrier improvement. Pruritus, fatigue, overall well-being, faecal calprotectin levels, and serum alkaline phosphatase did not change significantly.Conclusions: This study did not demonstrate a clinical improvement with short-term GFD in patients with PSC-IBD. However, a gluten/ATI-free diet may improve biomarkers of intestinal inflammation and barrier function in these patients with associatedThis is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Salidroside alleviates dextran sulfate sodium-induced colitis in mice by modulating the gut microbiota

“…A recent study reported that a gluten-free and amylase trypsin inhibitor (ATI)-free diet might improve the biomarkers of intestinal inflammation and barrier function in IBD patients with associated changes in the gut microbiota, including a decrease in the pathogen Romboutsia ilealis. 47 In addition, Liu et al demonstrated that 2′-fucosyllactose (2′FL) and galactooligosaccharide (GOS) could alleviate DSS-induced colitis in mice accompanied with the inhibition of Romboutsia and the enrichment of Akkermansia , Bifidobacterium , Faecalibaculum , and unclassified_f_Lachnosipiaceae. 48 In our study, the level of Romboutsia was decreased in the colitic mice treated with Sal and FMT compared when compared with that of colitic mice.…”

Effects of OsomeFood Clean Label plant-based meals on the gut microbiome

“…Probiotic consumption increases R. ilealis levels [ 54 ] and decreases pro-inflammatory plasma cytokines. In primary sclerosing cholangitis with inflammatory bowel disease, gluten-free diets reduced R. ilealis [ 55 ]. Similarly, in mice studies [ 56 ] of colitis, selenium-enriched Lactobacillus acidophilus improved Romboutsia -promoted intestinal inflammation and significantly reduced their levels.…”

Editorial: dietary interventions to understand and treat primary sclerosing cholangitis—is gluten‐free diet a starting point?

“…In a pilot study of gluten-free diet (GFD), Liwinski and Hübener et al have made a first attempt to describe the molecular effects of a dietary intervention in PSC. 5 In the study, 15 individuals with PSC-IBD completed 8 weeks of GFD, aiming to test the impact on colonic inflammation (sigmoidoscopy) and liver stiffness. An association between coeliac disease and PSC is well known.…”

“…The strong link between inflammation of both gut and liver points to the gut microbiome and interactions with dietary exposures as a potential player. In a pilot study of gluten‐free diet (GFD), Liwinski and Hübener et al have made a first attempt to describe the molecular effects of a dietary intervention in PSC 5 …”