Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jan;57(2):224-236.
doi: 10.1111/apt.17256. Epub 2022 Oct 20.

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

Timur Liwinski  1   2 , Sina Hübener  1 , Lara Henze  1 , Peter Hübener  1 , Melina Heinemann  1 , Marcus Tetzlaff  1 , Marie I Hiller  1 , Bettina Jagemann  1 , Rambabu Surabattula  3 , Diana Leeming  4 , Morten Karsdal  4 , Erika Monguzzi  3 , Guido Schachschal  5 , Thomas Rösch  5 , Corinna Bang  6 , Andre Franke  6 , Ansgar W Lohse  1   7 , Detlef Schuppan  3   8 , Christoph Schramm  1   7   9
Affiliations

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

Timur Liwinski et al. Aliment Pharmacol Ther. 2023 Jan.

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 eight-week 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 associated changes in the enteric microbiota. Further investigation of the therapeutic potential of the GFD in PSC-IBD is warranted.

Trial registration: ClinicalTrials.gov NCT04006886.

PubMed Disclaimer

Comment in

References

REFERENCES

    1. Yokoda RT, Carey EJ. Primary biliary cholangitis and primary sclerosing cholangitis. Am J Gastroenterol. 2019;114(10):1593-605. https://doi.org/10.14309/ajg.0000000000000268
    1. Loftus EV, Harewood GC, Loftus CG, Tremaine WJ, Harmsen WS, Zinsmeister AR, et al. PSC-IBD: a unique form of inflammatory bowel disease associated with primary sclerosing cholangitis. Gut. 2005;54(1):91-6. https://doi.org/10.1136/gut.2004.046615
    1. Ali AH, Tabibian JH, Nasser-Ghodsi N, Lennon RJ, DeLeon T, Borad MJ, et al. Surveillance for hepatobiliary cancers in patients with primary sclerosing cholangitis. Hepatology. 2018;67(6):2338-51. https://doi.org/10.1002/hep.29730
    1. Soetikno RM, Lin OS, Heidenreich PA, Young HS, Blackstone MO. Increased risk of colorectal neoplasia in patients with primary sclerosing cholangitis and ulcerative colitis: a meta-analysis. Gastrointest Endosc. 2002;56(1):48-54. https://doi.org/10.1067/mge.2002.125367
    1. Dean G, Hanauer S, Levitsky J. The role of the intestine in the pathogenesis of primary sclerosing cholangitis: evidence and therapeutic implications. Hepatology. 2020;72(3):1127-38. https://doi.org/10.1002/hep.31311

Publication types

Associated data

LinkOut - more resources