Dietary Therapy With the Crohn’s Disease Exclusion Diet is a Successful Strategy for Induction of Remission in Children and Adults Failing Biological Therapy

Boneh, Rotem Sigall; Shabat, Chen Sarbagili; Yanai, Henit; Chermesh, Irit; Ben-Avraham, Sivan; Boaz, Mona; Levine, Arie

doi:10.1093/ecco-jcc/jjx071

Cited by 140 publications

(148 citation statements)

References 26 publications

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“…Brand‐specific [(Modulen (Nestle Health Science, Epalinges, Switzerland), Osmolite (Abbott Australasia, Macquarie Park NSW, Australia), Paediasure (Abbott Australasia, Macquarie Park NSW, Australia), and Ensure Plus (Abbott Australasia, Macquarie Park NSW, Australia)] and generic EEN formulas have been trialed. Juice‐based polymeric formulas have not been reported . This may be because juice‐based formulas tend to be higher in osmolarity, lower in protein, and lack fat‐soluble vitamins.…”

Section: Resultsmentioning

confidence: 99%

Exclusive enteral nutrition: An optimal care pathway for use in adult patients with active Crohn's disease

et al. 2019

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Background and Aim Exclusive enteral nutrition (EEN) is progressively being used as a therapeutic option for adults with Crohn's Disease (CD); however, there is no standardized approach to delivering this therapy. The aim of this study is to develop an optimal care pathway for using EEN in adults with CD. This will create a standard of care that can be used as a benchmark practice and will provide direction for future research. Methods A working group of 12 multidisciplinary inflammatory bowel disease specialists across Australia and New Zealand was convened to develop a practical, clinically focused care pathway for using EEN in adults with active CD. Six key areas were identified as part of the care pathway: clinical indications, nutrition assessment, EEN protocol, monitoring, accessing formula, and food reintroduction. Current literature was identified via systematic review, and quality of evidence was graded. Consensus expert opinion was used where literature gaps were identified. Results An optimal care pathway for using EEN in adults with CD was developed with six key consensus statements on how to use EEN in adults with active CD. These key statements identify clinical indications for use, nutrition assessment, enteral prescription and duration of therapy, monitoring criteria, food reintroduction, and the role of partial EEN. An accompanying patient resource was also developed. Conclusion EEN is recommended as a treatment option to induce remission in adults with active CD. The consensus statements developed are practical and are based on best available evidence and expert opinion to assist in developing a standardized approach to delivering EEN therapy.

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Section: Resultsmentioning

confidence: 99%

Exclusive enteral nutrition: An optimal care pathway for use in adult patients with active Crohn's disease

et al. 2019

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“…This diet was subsequently evaluated for induction of remission in children and adults failing biologics. Among 21 patients with active disease after loss of response to biologics despite dose escalation or combination therapy, 61% achieved clinical remission, again with a significant drop in inflammatory markers 78. While limited by design, these two retrospective studies reported remission with an exclusion diet at both ends of the spectrum of clinical disease, suggesting that diet may be an important tool for controlling active disease even in established disease and among biologic unresponsive patients.…”

Section: Introductionmentioning

confidence: 97%

Evolving role of diet in the pathogenesis and treatment of inflammatory bowel diseases

Levine

Boneh

Wine

2018

Gut

Self Cite

285

284

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Recent advances in basic and clinical science over the last 3 years have dramatically altered our appreciation of the role of diet in inflammatory bowel diseases (IBD). The marked increase in incidence of these diseases along with the important role of non-genetic susceptibility among patients with IBD has highlighted that these diseases have a strong environmental component. Progress in the field of microbiome and IBD has demonstrated that microbiome appears to play an important role in pathogenesis, and that diet may in turn impact the composition and functionality of the microbiome. Uncontrolled clinical studies have demonstrated that various dietary therapies such as exclusive enteral nutrition and newly developed exclusion diets might be potent tools for induction of remission at disease onset, for patients failing biologic therapy, as a treatment for disease complications and in reducing the need for surgery. We review these advances from bench to bedside, along with the need for better clinical trials to support these interventions.

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“…Outside of using EN, there are several different diets or dietary restrictions being studied in CD. Examples of such diets include CD exclusion diet, which is described in a recent publication and found to induce remission in patients who are not responding to escalating doses of biologic therapy; low Fermentable, Oligo‐, Di‐, Mono‐saccharides And Polyols (FODMAP) diet; and specific carbohydrate diet . A detailed description of these diets is beyond the scope of this manuscript; the reader is referred to comprehensive reviews of different diets in inflammatory bowel disease …”

Section: Factors Potentially Affecting the Efficacy Of Enmentioning

confidence: 99%

Enteral Nutrition for Pediatric Crohn's Disease: An Underutilized Therapy

Shaikhkhalil

Crandall

2018

Nut in Clin Prac

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Enteral nutrition (EN) for the treatment of Crohn's disease (CD) involves administration of a liquid nutrition product, administered orally or through tube feeding, while excluding typical dietary components. It is a safe and effective, but largely underused, therapy in the United States as a treatment for CD. EN is a particularly attractive option for pediatric CD as it avoids side effects of corticosteroids, improves growth, and may have a higher likelihood of achieving mucosal healing than some traditional medications. However, there are multiple real and perceived barriers to its use among providers. A comprehensive approach to addressing these barriers to EN may result in its increased use. This paper reviews the literature on the efficacy of EN, methods of utilization, and potential barriers and solutions to those barriers.

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Dietary Therapy With the Crohn’s Disease Exclusion Diet is a Successful Strategy for Induction of Remission in Children and Adults Failing Biological Therapy

Abstract: Dietary treatment combining PEN with the CDED may be a useful salvage regimen for patients failing biological therapy despite dose escalation.

Cited by 140 publications

References 26 publications

Exclusive enteral nutrition: An optimal care pathway for use in adult patients with active Crohn's disease

Exclusive enteral nutrition: An optimal care pathway for use in adult patients with active Crohn's disease

Evolving role of diet in the pathogenesis and treatment of inflammatory bowel diseases

Enteral Nutrition for Pediatric Crohn's Disease: An Underutilized Therapy

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