Enhancing oral mesalazine efficacy in ulcerative colitis through an anti-inflammatory diet: An exploratory double-blinded randomised feeding trial.

Inflammatory Bowel Diseases (IBD), including Crohn’s disease and ulcerative colitis (UC), are chronic conditions characterised by gastrointestinal inflammation. While the exact causes remain unclear, both genetic and environmental factors—particularly changes in the gut microbiota—play major roles.

IBD is increasingly prevalent worldwide, and evidence suggests that diet significantly influences disease outcomes. Diets high in ultra-processed foods, fats, and red meat are associated with higher relapse rates in UC, while high-fibre, low-fat diets may help reduce inflammation and improve quality of life.

This study will explore whether an anti-inflammatory diet can enhance the clinical effectiveness of oral mesalazine (5-ASA), the standard first-line treatment for newly diagnosed mild to moderate UC. Using a cutting-edge multi-omics approach, we will examine the interactions between diet, the gut microbiome, inflammation, and drug metabolism.

• Test the feasibility and acceptability of a control (sham) diet.
• Assess the impact of diet on treatment response and quality of life.
• Use multi-omics techniques to analyse the effects of diet and mesalazine on the gut ecosystem (oral/
• faecal microbiome, bile acids, short-chain fatty acids, drug acetylation).
• Measure luminal environment and gut motility using a novel ingestible gas-sensing capsule.
• Investigate changes in gut permeability.
• Develop biomarkers for dietary adherence.
• Biobank biological samples for future research.

This is a prospective, randomised, double-blinded, placebo-controlled dietary intervention trial.

Participants with newly diagnosed mild to moderate UC will be randomised to receive either: Oral mesalazine + our previously validated Modified Anti-Inflammatory Diet (MAID), or Oral mesalazine + a matched SHAM diet.

Many UC patients are eager to explore dietary options alongside medication, but robust evidence is lacking. This project aims to close that gap and assess how dietary strategies may enhance the efficacy of existing therapies.

By examining not only clinical outcomes but also mental health, anxiety, gastrointestinal symptoms, and overall quality of life, this study takes a comprehensive, patient-centred approach to managing UC.

You’ll join a highly collaborative, well-supported team with expertise in metabolomics, microbiome science, nutrition, and clinical IBD research, based across QIMR Berghofer, The University of Queensland, Monash University, and UNSW.

We aim to generate evidence that supports integrating dietary therapy with conventional drug treatment, potentially reducing the need for aggressive immunosuppressive therapies and offering a more personalised and sustainable approach to managing UC.