Study Looks at Benefits of Gluten-free Diet for Primary Sclerosing Cholangitis and Inflammatory Bowel Disease

Celiac.com 06/26/2023 - Primary sclerosing cholangitis (PSC) is a progressive bile duct disease often associated with inflammatory bowel disease (IBD). Managing these conditions can be challenging, and researchers are constantly exploring new approaches to improve patient outcomes. 

A team of researchers recently set out to investigate whether patients with PSC-IBD could benefit from a gluten-free diet combined with the exclusion of amylase trypsin inhibitors (ATIs).

Study Design

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The team conducted a prospective clinical pilot study on 15 patients diagnosed with PSC-inflammatory bowel disease. The participants were placed on an eight-week gluten-free diet. The study aimed to evaluate primary outcomes such as colonic inflammation, assessed through proctosigmoidoscopy, and liver stiffness, measured as a surrogate for fibrosis, inflammation, and cholestasis, using transient elastography. The researchers also examined secondary outcomes including changes in colonic mucosal and serum cytokines/chemokines, intestinal microbiome composition, transcriptome dynamics, and serum markers of hepatic fibrogenesis.

Results and Findings - Improvement in Gut Barrier Function

Although the study did not demonstrate a clinical improvement in the primary outcomes of colonic inflammation and liver stiffness, several noteworthy findings emerged. The expression of pro-inflammatory mucosal cytokines and chemokines, including IL6, IL8, CCL2, and TNFα, was significantly down-regulated. Additionally, two critical markers of liver fibrosis and matrix remodeling, thrombospondin-2 and -4, showed significant decreases.

Furthermore, the composition of the intestinal microbiota underwent slight changes, with a decrease in the pathogen Romboutsia ilealis. Analysis of the intestinal transcriptome suggested an improvement in gut barrier function. However, factors such as pruritus, fatigue, overall well-being, faecal calprotectin levels, and serum alkaline phosphatase did not exhibit significant changes.

Implications and Future Research

Although the short-term gluten-free diet did not lead to noticeable clinical improvements in patients with PSC-inflammatory bowel disease, the study revealed potential benefits. The down-regulation of pro-inflammatory cytokines and chemokines, as well as the reduction in markers associated with liver fibrosis, indicate potential for mitigating intestinal inflammation, and improving liver health.

Moreover, the slight alterations in the intestinal microbiota composition and improved gut barrier function offer further insights into the complex interplay between diet, gut health, and disease progression. 

While the findings are promising, it is important to note that this study was a pilot investigation with a small sample size. Therefore, further research with larger cohorts and longer durations is necessary to fully understand the therapeutic potential of a gluten-free diet in managing PSC-inflammatory bowel disease.

Read more in Global Pediatric Health. 2021;8.

The research team included Timur Liwinski; Sina Hübener; Lara Henze; Peter Hübener; Melina Heinemann; Marcus Tetzlaff; Marie I. Hiller; Bettina Jagemann; Rambabu Surabattula; Diana Leeming; Morten Karsdal; Erika Monguzzi; Guido Schachschal; Thomas Rösch; Corinna Bang; Andre Franke; Ansgar W. Lohse; Detlef Schuppan; and Christoph Schramm.

They are variously affiliated with the Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; the Center for Affective, Stress and Sleep Disorders (ZASS), University Psychiatric Clinics (UPK) Basel, University of Basel, Basel, Switzerland; the Institute of Translational Immunology and Research Center for Immunotherapy, University Medical Center, Johannes Gutenberg University, Mainz, Germany; the Research and Development, Nordic Bioscience, Biomarkers and Research A/S, Herlev, Denmark; the Department of Interdisciplinary Endoscopy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; the Institute for Clinical Molecular Biology, Christian Albrechts University of Kiel, Kiel, Germany; the Hamburg Center for Translational Immunology, Hamburg, Germany; the Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA; and the Martin Zeitz Center for Rare Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.