Oral butyrate for mildly to moderately active Crohn's disease

DI SABATINO, A.
MORERA, R.
CICCOCIOPPO, R.
CAZZOLA, P.
GOTTI, S.
TINOZZI, F. P.
TINOZZI, S.
CORAZZA, G. R.

^*First Department of Medicine, IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy
^†Department of Surgery, IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy
^‡Medical Department, Promefarm s.r.l., Milan, Italy

Correspondence to: Prof. G. R. Corazza, Clinica Medica I, IRCCS Policlinico San Matteo, Università di Pavia, Piazzale Golgi 5, 27100 Pavia, Italy. E-mail: [email protected]

Accepted for publication 21 July 2005

Alimentary Pharmacology & Therapeutics 22(9):p 789-794, November 2005.

SUMMARY

Background

Butyrate exerts anti-inflammatory effects in experimental colitis and on Crohn's disease lamina propria mononuclear cells in vitro.

Aim

To explore the efficacy and safety of oral butyrate in Crohn's disease.

Methods

Thirteen patients with mild–moderate ileocolonic Crohn's disease received 4 g/day butyrate as enteric-coated tablets for 8 weeks. Full colonoscopy and ileoscopy were performed before and after treatment. Endoscopical and histological score, laboratory data, Crohn's disease activity index and mucosal interleukin (IL)-1β, IL-6, IL-12, interferon-γ, tumour necrosis factor-α and nuclear factor-kappa B (NF-κB) were assessed before and after treatment.

Results

One patient withdrew from the study, and three patients did not experience clinical improvement. Among the nine patients (69%) who responded to treatment, seven (53%) achieved remission and two had a partial response. Endoscopical and histological score significantly improved after treatment at ileocaecal level (P < 0.05). Leucocyte blood count, erythrocyte sedimentation rate and mucosal levels of NF-κB and IL-1β significantly decreased after treatment (P < 0.05).

Conclusions

Oral butyrate is safe and well tolerated, and may be effective in inducing clinical improvement/remission in Crohn's disease. These data indicate the need for a large investigation to extend the present findings, and suggest that butyrate may exert its action through downregulation of NF-κB and IL-1β.