Lifestyle-related disease in Crohn’s disease: Relapse prevention by a semi-vegetarian diet

AIM: To investigate whether semi-vegetarian diet (SVD) has a preventive effect against relapse of Crohn’s disease (CD) in patients who have achieved remission,who are a high-risk group for relapse.METHODS: A prospective,single center,2-year clinical trial was conducted.Twenty-two adult CD patients who achieved clinical remission either medically (n = 17) or surgically (n = 5) and consumed an SVD during hospitalization were advised to continue with an SVD and avoid known high-risk foods for inflammatory bowe...

Lifestyle-related disease in Crohn's disease: Relapse prevention by a semi-vegetarian diet

AIM: To investigate whether semi-vegetarian diet (SVD) has a preventive effect against relapse of Crohn's dis-ease (CD) in patients who have achieved remission, who are a high-risk group for relapse. METHODS: A prospective, single center, 2-year clini-cal trial was conducted. Twenty-two adult CD patients who achieved clinical remission either medically (n = 17) or surgically (n = 5) and consumed an SVD dur-ing hospitalization were advised to continue with an SVD and avoid known high-risk foods for inflamma-tory bowel disease. The primary endpoint was clinical relapse defined as the appearance of active symptoms of CD. Kaplan-Meier survival analysis was used to cal-culate the cumulative proportion of patients who had a relapse. A 2-year analysis of relapse rates of patients who followed an SVD and those who did not (an om-nivorous diet group) was undertaken. RESULTS: SVD was continued by 16 patients (com-pliance 73%). Remission was maintained in 15 of 16 patients (94%) in the SVD group vs two of six (33%) associations with various clinicopathologic parameters of adenomas i.e. gender, age, localization, grade of dys-plasia, size and configuration. RESULTS: Patient age ranged from 41 to 84 years (mean 65 ± 13.2 years); 37 patients were males and 18 were females. Adenomas ranged in size between 0.5 and 30 cm (mean 2 ± 1.3 cm), including 18 tubular, 16 vil-lous, 20 mixed or tubulovillous, and 1 giant sessile vil-lous adenoma. AMACR expression was observed in 3 out of 16 (18.8%) of low-grade vs 23 out of 35 (62.8%) of high-grade lesions (P = 0.002). Most adenomas ex-hibiting high grade dysplasia with in situ carcinoma-like areas stained positive for AMACR (15/17 or 88.2%) as compared to adenomas with high grade dysplasia which contained severe dysplasia-like foci (6/15 or 40%), (P = 0.005). In AMACR positive adenomas featuring severe dysplasia-like or in situ carcinoma-like areas, AMACR staining was not necessarily observed in the in situ com-ponent. Positivity in intra-lesion of mild, moderate or se-vere dysplasia-like foci was more often encountered in adenomas harboring in situ, intramucosal or infiltrative carcinoma [21/33 (63.6%) vs 9/40 (22.5%), P < 0.001]. Strong AMACR expression was found in 11 out of 17 vil-lous adenomas, but in only 1 out of 18 tubular lesions (P = 0.005). Larger lesions, i.e. > 1 cm stained more fre-quently for AMACR than smaller ones [27/45 (60%) vs 2/10 (20%), P = 0.02]. Overall, AMACR expression was associated with the grade of dysplasia, as well as with the size and configuration of adenomas, i.e. the consen-sus risk factors applied to colorectal adenoma patient surveillance. CONCLUSION: It may be worthy to further evaluate the possible use of AMACR as an additional risk factor for the assessment of colorectal adenoma patients.