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Community Types of the Human Gut Virome are Associated with Endoscopic Outcome in Ulcerative Colitis

Daan Jansen, Gwen Falony, Sara Vieira-Silva, Ceren Simsek, Tine Marcelis, Clara Caenepeel, Kathleen Machiels, Jeroen Raes, Séverine Vermeire, Jelle Matthijnssens

Published: 24 April 2023, Journal of Crohn's and Colitis


Background & aims:

Dietary patterns are important in managing ulcerative colitis (UC), given their influence on gut microbiome-host symbiosis and inflammation. We investigated whether the Mediterranean Diet Pattern (MDP) vs the Canadian Habitual Diet Pattern (CHD) would impact disease activity, inflammation and the gut microbiome in patients with quiescent UC.


We performed a prospective, randomized control trial in adults (65% female; median age 47 y) with quiescent UC in an outpatient setting from 2017 to 2021. Participants were randomized to a MDP (n=15) or CHD (n=13) for 12 weeks. Disease activity (Simple Clinical Colitis Activity Index) and fecal calprotectin (FC) were measured at baseline and week 12. Stool samples were analyzed by 16S rRNA gene amplicon sequencing.


The diet was well-tolerated by the MDP group. At week 12, 75% (9/12) of participants in the CHD had a FC >100 μg/g, versus 20% (3/15) of participants in the MDP group. The MDP group had higher levels of total fecal short-chain fatty acids (SCFAs) (p=0.01), acetic acid (p=0.03) and butyric acid (p=0.03) compared to the CHD. Furthermore, the MDP-induced alterations in microbial species associated with a protective role in colitis (Alistipes finegoldii and Flavonifractor plautii), as well as the production of SCFAs (Ruminococcus bromii).


A MDP induces gut microbiome alterations associated with the maintenance of clinical remission and reduced FCin patients with quiescent UC. The data supports that a MDP is a sustainable diet pattern that could be recommended as a maintenance diet and adjunctive therapy for UC patients in clinical remission.


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