P2143 - The Role of Fermented Food in Inflammatory Bowel Disease Treatment: A Systematic Review of Randomized Trials

Monday, October 23, 2023

10:30 AM – 4:15 PM PT

Location: Exhibit Hall

Presenting Author(s)

Zoya Grigoryan, MD, MA (she/her/hers)

Northwell Health-Lenox Hill Hospital
New York, NY

Alexandra Feathers, MPH, MPA¹, Zoya Grigoryan, MD, MA¹, Louise Falzon, ², Jessica Mineroff, BS³, Arun Swaminath, MD¹
¹Northwell Health-Lenox Hill Hospital, New York, NY; ²School of Health and Related Research, The University of Sheffield, Sheffield, England, United Kingdom; ³SUNY Downstate Medical Center, State University of New York, Downstate Health Sciences University, New York, NY

Introduction: Over the past 30 years, Inflammatory Bowel Diseases (IBD) incidence has escalated throughout North America. Although researchers have identified a clear genetic component accounting for 25% of IBD transmissibility, scientific consensus suggests that a majority of cases are modulated by environmental factors, with strong influence from the gut microbiome. A recent increase in IBD prevalence, paralleling dramatic historical economic changes, has also been demonstrated in Asia, Africa and South America. Research into controllable lifestyle factors has the potential to improve the lives of this patient population. Although a significant body of data indicates that gut dysbiosis plays a strong role in the disease, diet impact is underrepresented in currently published IBD management guidelines. Fermented foods (FF) are believed to affect the microbiome in part because of their high content of specific strains such as lactobacillus. Probiotic therapy effect on IBD has yielded conflicting results, however such products are isolated components, removed from their initially complex micro-community offered by FF where the environment modulates functional expression. We have conducted a systematic review on studies evaluating the effect of whole FF itself on IBD outcomes.

Methods: We searched MEDLINE, EMBASE, AMED, The Cochrane Library, Epistemonikos, Clinicaltrials.gov and the WHO Clinical Trials Registry Platform for publications before June 2021. Randomized or observational studies with at least one FF arm FF were included. Studies without clearly defined endpoint were excluded. Pooled analysis was conducted in RevMan 5.0 comparing remission maintenance in IBD patients consuming FF and placebo.

Results: Of 861 records analyzed, 6 studies met our PICOS criteria for qualitative analysis. 2 studies were included in quantitative analysis, which did not reach statistical significance. Overall, FF interventions were almost universally well-tolerated with minimal adverse effects among experimental arms. 1 RCT demonstrated a significant reduction in UC exacerbations in the FF group. 4 of 6 studies in qualitative analysis had clinically better outcomes in FF groups.

Discussion: There is a paucity of data on the effect of FF on IBD, despite relevance and public demand for more evidence-based dietary recommendations. A low adverse effect profile and early promising data suggest there is room to explore this potentially valuable dietary component of IBD management.

Figure: Figure 1. PRISMA flow chart.

Authors	Biases	Comparator Arms	Number of Participants	Disease Status	IBD Type	Outcome	Outcome Measurement
Kato et al. 2004	RCT Placebo Controlled	Bifido Bacteria Fermented Milk + Conventional Care vs. Conventional Care Only	20	Active Disease	UC	Clinical Response, Clinical Remission, Endoscopic Remission and Histologic Remission	CAI and MARKS endoscopic score
** Matsuoko et al. 2018	RCT Double Blind, Placebo Controlled	Bifido Bacteria Fermented Milk + 5-ASA vs. Placebo + 5-ASA	192	Remission	UC	Remission Maintenance	Sutherland Disease Activity Index
Yilmaz et al. 2019	RCT no placebo, no blinding	Kefir + Conventional Care vs. Conventional Care Only	45	Active Disease	CD & UC	Microbiota Composition, Clinical Improvement	PCR and Symptom Diary, non standardized score
Shadnoush et al. 2015	RCT Placebo Controlled	Probiotic yogurt+ Conventional Care vs. Conventional Care + Placebo	210	Remission	CD & UC	Mean numbers of fecal: lactobacillus, bifidobacterium, bacteriodes	PCR
Shadnoush et al. 2013	RCT Placebo Controlled	Probiotic yogurt+ Conventional Care vs. Conventional Care + Placebo	210	Remission	CD & UC	CRP levels and Blood Cytokines: TNF-alpha, IL-10, IL-6	ELISA
** Ishikawa et al. 2013	RCT	BFM x 1 year versus no fermented milk products x 1 year	21	Active Disease	UC	Remission Maintenance	Monthly symptom reports

Disclosures:

Alexandra Feathers indicated no relevant financial relationships.

Zoya Grigoryan indicated no relevant financial relationships.

Louise Falzon indicated no relevant financial relationships.

Jessica Mineroff indicated no relevant financial relationships.

Arun Swaminath indicated no relevant financial relationships.

Alexandra Feathers, MPH, MPA¹, Zoya Grigoryan, MD, MA¹, Louise Falzon, ², Jessica Mineroff, BS³, Arun Swaminath, MD¹. P2143 - The Role of Fermented Food in Inflammatory Bowel Disease Treatment: A Systematic Review of Randomized Trials, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.