## 3 Results
### Phytochemical or Plant Extract Effectiveness on IBD Patients
The effectiveness of isolated phytochemicals or plant extracts derived from cannabis on IBD patients, delivered in various forms and modes of administration, i.e., orally, sublingually or by inhalation as pills, essential oils, teas, cigarettes or vapors, was reviewed. Significant improvement was reported in quality of life and maybe in reduction of hospital stays, while cannabinoids did not seem to induce remission or changes in inflammatory biomarkers. More uniform trials with different and discrete doses of substances like cannabidiol or tetrahydroocannabinol and outcomes like inflammatory markers, endoscopy, disease activity index, adverse events and quality of life questionnaires are needed. Until then, caution is recommended, and cannabinoids should be reserved for patients with low quality of life or as an adjunct to established medication as suggested by the authors [56]. Oligrotrucose and Inulin or FOS are phytochemicals that have been studied in IBD patients as complementary medicine. Three included clinical studies documented the results of administering FOS supplements to a total of 146 recruited CD patients [21; 47; 54]. Two other studies evaluated FOS given to 50 UC patients [23; 55]. FOS supplement Synergy18 was given in 4 studies, and in 1 CD study, Prebio 19 supplement was used. In UC patients, the studies concluded that gut microbiota composition and fecal caloprotectin levels were improved without having evident clinical significance [23; 55]. Combined with mesalazine, FOS can be effective and safe. Initially, small open label studies suggested that CD activity decreased and intestinal bifidobacteria counts increased [54]. Conversely, in a later RCT, 103 CD patients experienced more functional gastrointestinal symptoms receiving FOS supplements without clinical benefit [21]. Moreover, it was proposed that FOS supplements did not provide benefit to CD patients but could protect at-risk individuals like their healthy siblings [47]. The addition of probiotics, i.e., live microbes such as _Bifidobacterium longun_, to FOS creates supplements known as synbiotics. A combination of Synergy18 with _Bifidobacterium longun_ increased bifidobacteria populations while reducing IL-1a and TNF-a in intestinal tissues. This was associated with clinical benefits for UC patients, as shown in an RCT with 18 active UC patients [26]. Similarly, the administration of this symbiotic to CD patients for 6 months showed a TNF-a reduction along with microbiota composition, clinical symptoms and histology improvement [43]. Footnote 18: [[https://www.cds.org/](https://www.cds.org/)]([https://www.cds.org/](https://www.cds.org/))  
The phytochemical with the most included studies regarding its application for IBD treatment is curcumin. As it is a well-known food additive with anti-inflammatory and antioxidant properties, it seems logical to explore its potential as a therapeutic agent for IBD. A pilot study of curcumin for UC and CD showed improvements in proctitis and inflammatory markers [50]. Another pilot study of curcumin use by pediatric IBD patients indicated that curcumin decreased relapse and recurrence rates with clinical and endoscopic disease activity index improvements [49]. Several RCTs that were conducted reached the same conclusions with statistical significance [20; 28; 31; 33; 39; 44]. Two of them utilized novel curcumin derivatives, like Theracurmin(r) or bio-enhanced curcumin that exhibit higher bioavailability [20; 44]. In contrast to this, another RCT demonstrated no statistically significant effect on IBD patients with lower dosages of curcumin, suggesting a dose dependent effect [30]. Some RCTs also report improvements in self-reported quality of life [33; 39]. The aforementioned studies ratify curcumin's safety and lack of serious adverse events. Special mention must be made to a study investigating the use of NCB-02, a curcumin enema that displays similar results but without statistical significance [42].