Long-term double-blind study on the influence of dietary fibres on faecal bile acid excretion in juvenile ulcerative colitis

Abstract

A double-blind cross-over long-term trial (18 months) with randomized supplementation with wheat fibre or ispaghula for two periods of six months, separated by a six-month wash-out period with placebo, was performed in ten patients with juvenile ulcerative colitis to study the effect on faecal bile acid (BA) excretion. All patients were in remission since 0.5-2 years and orally treated with sulphasalazine. The average intake of either fibres was 16 g day-1. Faecal samples were collected (72 h) before and after each fibre period. Faecal water were prepared by centrifugation of faeces at 15,000 g for 2 h. BA in faeces and faecal water were studied using capillary column gas-liquid chromatography-mass spectrometry. Faecal excretion of total BA were not significantly changed by the two fibres. Supplementation with wheat fibre, but not with ispaghula, decreased the faecal concentration of total BA by 43% (p < 0.05), unconjugated BA by 41% (p < 0.01), and taurine conjugated BA by 58% (p < 0.05). Addition of wheat fibre decreased the concentration of chenodeoxycholic acid by 66% (p < 0.05) and isomers of cholic acid by 51% (p < 0.05) in faeces. The mean faecal water concentration of taurine-conjugated BA decreased by 55% when wheat fibre was added (p < 0.05) and the concentration of isomers of deoxycholic acid increased by 39% when ispaghula was supplemented (p < 0.05). The ratio isomeric deoxycholic acid to deoxycholic acid in faecal water increased significantly when wheat fibre was added (p < 0.05). The percentage distribution of secondary and ketonic BA was not influenced by the dietary fibre supplementation. The concentration of BA in faeces and faecal water decreased only by wheat fibre, suggesting that it is superior in obtaining an affect on faecal BA concentration.

Potential Benefits of Dietary Fibre Intervention in Inflammatory Bowel Disease

“…A randomised crossover study investigated the intake of wheat bran and psyllium in two six-month intervention periods, with a six-month washout period using a placebo of molded crisps between (we note that the nature of the crisps was not defined in the original paper) [ 73 ]. Ejderhamn et al showed that there were differences between the two DF supplements in children with inactive UC.…”

“…As previously discussed, Ejderhamn et al performed a randomised crossover study to compare the intake of WB and psyllium in two six-month intervention periods, with a six-month washout period [ 73 ]. WB intake was associated with significant reductions in faecal bile acid concentrations.…”

Germinated barley foodstuff, a prebiotic product, ameliorates inflammation of colitis through modulation of the enteric environment

“…26 Bile acid may increase the risk of colonic dysplasia or cancer, especially in UC patients. 27,28 Also, these patients may have higher levels of carcinogenic secondary bile acids and, thus, be more likely to develop cancer on the right side of the colon, where secondary bile acid concentrations are highest. 37,38 Therefore, it is important to investigate whether GBF eliminates bile acids in vivo.…”

Nutrition in Pediatric Inflammatory Bowel Disease

“…Although no specific pediatric study has been performed, several trials in adults have evaluated the effectiveness and mechanisms of action of fiber in IBD. Based on the published RCT in adults and on 3 systematic reviews, there is limited evidence for the effectiveness of fiber supplementation in active UC and in maintenance of remission in UC and pouchitis (253,254,(263)(264)(265)(266)(267)(268)(269)(270)(271)(272)(273)(274). Data in active UC are conflicting, Copyright © ESPGHAN and NASPGHAN.…”