Diet as therapeutic intervention in Crohn’s disease

Abstract

Diet plays an important role in the pathogenesis of inflammatory bowel disease. It has an impact on microbiome, host barrier, and immune response. Clinical studies indicate that various dietary interventions such as exclusive enteral nutrition and exclusion diets might be useful for induction of remission in mild to moderate Crohn's disease, but also for patients failing biological therapy. Current treatment strategies try to solve the problem of poor patient compliance due to the required strict dietary regime. The number of adverse events associated with the use of dietary alternatives is incomparable with the side effects of glucocorticosteroids or biological treatment, which makes them a tempting therapeutic option.

Nutritional aspects in autoimmune diseases undergoing hematopoietic stem cell transplantation: overview and recommendations on behalf of the EBMT ADWP and Nurses Group

“…In addition, a series of nutritional deficiencies characterize this group of patients, such as a lack of folate and vitamins A and D, and B12 malabsorption in the case of extensive bowel resections ( 74 ). Nutrition plays a fundamental role in reducing the symptoms associated with CD or in maintaining remission ( 75 ), and those with refractory disease present frequently with signs of malnutrition and cachexia ( 73 ). Furthermore, TGF-beta2 enriched food for special medical purposes could reduce inflammation and bowel damage in active disease ( 76 ), incidence of severe and gut acute GvHD, pneumonia and hospitalization costs ( 77 ).…”

Selected Aspects of Nutrition in the Prevention and Treatment of Inflammatory Bowel Disease

“…Depending on the study, this could be as much as one-half of the subjects. The low rate of compliance with EEN recommendations was usually due to the flavor of the nutritional formula and patients’ unwillingness to feed exclusively on it [ 83 ]. For this reason, studies were undertaken to assess the efficacy of partial enteral feeding as regards the achievement of Crohn’s disease remission.…”

The significance of nutritional strategies in patients with inflammatory bowel disease in the context of malnutrition and the development of malnourished obesity

“…Given the increased prevalence of IBD, in countries that have adopted a western lifestyle, the prevailing theories suggest a significant contribution of the western diet to the development of IBD [1]. Current data indicate an increasing importance of environmental factors in the pathogenesis of CD [2]. In healthy individuals, the intestinal epithelium acts as a barrier to prevent foreign antigens, toxins, and microorganisms from entering the lumen of the epithelium.…”

“…It consists of a mucous layer, epithelial cells and tight junctions between cells. The colonic mucus should be impermeable to bacteria [2]. Identification of environmental risk factors with plausible biologic link to disease risk is vital to improve our understanding of disease pathophysiology and course.…”