Stepwise Treatment With Plant-Based Diet and Medication for Patient With Mild Ulcerative Colitis

INTRODUCTION: We regard inflammatory bowel disease as a lifestyle disease mainly mediated by a westernized diet. We developed a plant-based diet (PBD) to counter the westernized diet. PBD can induce remission without medication in a subset of mild cases of ulcerative colitis. Medication is provided when induction of remission is not achieved solely with PBD. We describe such a case in this report. CASE PRESENTATION: A 34-year-old woman visited us in October 2016 with a complaint of loose stool for nearly 5 years. Laboratory examination revealed mild abnormalities including elevation of C-reactive protein (CRP). Ulcerative colitis was diagnosed due to diffuse colonic inflammation and pathological findings consistent with ulcerative colitis. She was admitted for educational hospitalization for 19 days in the middle of November, during which PBD was provided. A few days after admission, her stool became normal. CRP concentration decreased to within the normal range. However, colonoscopy on discharge showed minimum improvement. Thereafter, CRP was abnormal on three successive occasions, and her stool alternated between normal and loose. Sulfasalazine was initiated at the end of March 2017. Thereafter, her stool was normally formed, and CRP decreased to normal. Endoscopic remission was confirmed in August. Her PBD score, which evaluates adherence to PBD, was 8 before admission, and 37 and 16 at 7 and 21 months after discharge, respectively. CONCLUSION: Medication was administered when restoration of a healthy dietary lifestyle was insufficient to induce remission. Our stepwise treatment makes the shift from one-size-fits-all medication toward medication to the right patient. REGISTRATION: http://www.umin.ac.jp UMIN000019061