Clinical Course and Dietary Patterns Among Patients Incorporating the Autoimmune Protocol for Management of Inflammatory Bowel Disease (P12-010-19)

Abstract

Introduction: Elimination diets, including the autoimmune protocol (AIP), may improve symptoms among patients with inflammatory bowel disease (IBD), but limited data exist on diet efficacy and utilization. Aims & Methods: The aim of our study was to examine clinical course and dietary patterns of patients with IBD utilizing AIP. We conducted an anonymous online survey sent through electronic newsletters and support groups utilizing AIP. The survey assessed demographics, IBD disease activity and medication use, including use of steroids and immunosuppression (biologics and/or immunomodulators). Participants were asked about AIP utilization and food group reintroductions. Symptom measures of abdominal pain, stool frequency, and rectal bleeding were compared at baseline (BL, prior to starting AIP), week 6 (after starting AIP), and present, separately for Crohn's disease (CD) and ulcerative colitis (UC). Results: There were 78 respondents who attempted AIP for management of IBD. Mean age was 39.4 years (SD 11.4), with mean IBD duration 13.2 yrs (SD 11.4), 78% prior steroid exposure, and 35% currently on immunosuppression. Seventy-three percent perceived achieving clinical remission due to AIP, but this was more common among patients not on immunosuppression (76% vs. 24% on immunosuppression, p< 0.001). After starting AIP, 32% reported being able to discontinue steroids. AIP was initiated according to protocol by 73%, while 27% modified it. Compared to BL, 6 weeks after starting AIP more patients with CD reported no abdominal pain (47% vs BL 17%, P = 0.01), normal stool frequency (53% vs BL 30%, P < 0.01), and no rectal bleeding (90% vs 43%, P = 0.057). Similarly, more patients with UC reported no abdominal pain (60% vs BL 14%, P < 0.01), normal stool frequency (47% vs BL 14%, P < 0.01), and no rectal bleeding (63% vs 30%, P < 0.01) 6 weeks after starting AIP, compared to BL. Food group reintroductions were started within 0-4 weeks of starting AIP among 8%, while 23% reintroduced within 5-8 weeks, 24% within 2-6 months, 23% within 6-12 months, and 13% after 12 months. Although success of food group reintroductions varied, this did not appear to affect symptom improvement, with majority of patients with IBD reporting no abdominal pain (80%), no rectal bleeding (72%), and normal stool frequency (64%) at present. Conclusion: In this retrospective study, patients utilizing AIP for management of IBD report clinical benefit, with reduction of steroid use and improvement in IBD symptoms, including with food group reintroduction.