Inns, S.J.; (2011) Food intolerance testing and dietary manipulation in inflammatory bowel disease. Doctoral thesis , UCL (University College London).

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Abstract

The aetiology of inflammatory bowel disease (IBD) combines genetic predisposition and environmental factors. In both ulcerative colitis and Crohn disease, patients perceive that diet affects the course of their disease. This thesis addresses the frequently observed compromise of the epithelial integrity of the gut in IBD and subsequent effect of the luminal content, which makes up the main part of the environmental stimulus, thus introducing the role of diet in IBD. Initially I conducted a survey, demonstrating the current practice of dietary manipulation and exclusion in IBD and irritable bowel syndrome, determining that advice given is generally empiric and that sensitivity testing is infrequently used in practice. A subsequent observational study compared the occurrence of serum IgG antibodies to foods in IBD patients compared to controls. It showed that IBD is associated with increased serum IgG antibodies to a wide range of foods but that this does not correlate with patient reported food intolerance. A further study investigated the colonic mucosal response to food antigen exposure, patient reported food intolerances, food specific serum IgG antibodies and intestinal permeability. The mucosal response did not correlate with patients' perception of food intolerance nor alterations in intestinal permeability. This work reinforces the importance of food intolerance in IBD and attempts to correlate those intolerances to available tests. While gastroenterologists do give dietary advice to their patients with IBD, the available evidence does not allow unequivocal advice. No objective relationship between patient-perceived food intolerance and hypersensitivity testing was demonstrated. Future studies should seek to clearly define the association between intolerance tests and patient symptoms, investigate the mechanisms by which such tests might predict intolerance, and investigate the most promising strategies in carefully designed and controlled studies of dietary intervention.

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