PTH-060 Clinical benefit of dietary advice in ulcerative colitis: results of a pilot study

Introduction

The subject of diet and ulcerative colitis is controversial. Patients believe dietary factors are important. Some research suggests dietary modification can bring real benefit to patients with UC. However, recognised dietary guidelines for use in UC do not exist. An educational booklet Diet and Ulcerative Colitis developed from preliminary focus group data (supported by an educational grant from P&G pharmaceuticals), provided dietary principles and advice for UC flare-ups and was based on a high protein, low fat, low carbohydrate and low fibre diet.

Methods

The purpose of the pilot study was to test the efficacy of dietary modification in UC. The standardised dietary advice booklet Diet and Ulcerative Colitis was given to 64 UC patients. Disease activity was assessed using Simple Clinical Colitis Activity Index (SCCAI), gastrointestinal symptom-specific anxiety was determined using Visceral Sensitivity Index (VSI) and a study designed food frequency questionnaire was used to measure compliance with dietary advice. Symptoms were reassessed by repeated completion of SCCAI, VSI and food frequency questionnaire after 6 months.

Results

The mean age of participants was 48 (range 22–81 years). 47% of participants were male. 73% of the sample was Caucasian, 27% South Asian. On entry to the study, 55% participants had a high VSI—the level of gastrointestinal symptom-specific anxiety, 33% had a moderately high VSI and 13% (eight people) did not show any symptom-specific anxiety. Paired t test showed that compliance with dietary advice was associated with a significant decrease in SCCAI (t=2.5364, p=0.007) and highly significant in the reduction of VSI (t=−4.5351, p<0.0001). Correlation between SCCAI and VSI was significant (p<0.01). It appeared that patients9 symptom-anxiety level is directly dependent on the severity of symptoms in UC. Thirteen participants (20%) with the highest clinical activity (SCCAI range 5–12) noted significant reduction of the symptoms severity, following dietary advice (SCCAI range 2–8). 74% of study participants found dietary advice helpful and 54% of UC patients reported feeling more confident about controlling diarrhoea, bloating and pain. 98% of patients reported that information given in the booklet was easy to read and understand.

Conclusion

This dietary advice was viewed by patients as beneficial in overcoming symptom-specific anxiety and effective in self-management of UC symptoms, especially during flare-ups. We conclude that dietary modification should be considered as an additional therapeutic factor in UC treatment.