Dietary Therapies Induce Rapid Response and Remission in Pediatric Patients With Active Crohn’s Disease

Boneh, Rotem Sigall; Limbergen, Johan Van; Wine, Eytan; Assa, Amit; Shaoul, Ron; Milman, Peri; Cohen, Shlomi; Kori, Michal; Peleg, Sarit; On, Avi; Shamaly, Hussein; Abramas, Lee; Levine, Arie

doi:10.1016/j.cgh.2020.04.006

Cited by 56 publications

(78 citation statements)

References 22 publications

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“…CDED + PEN and EEN showed equal effectiveness in inducing remission at week 6, with remission rates around 85%. In addition, 80% of children with a response to EEN or CDED + PEN at week 3 reached clinical remission at week 6 [103]. However, CDED + PEN demonstrated better tolerance by children and their parents at week 6, addressing the adherence challenges of EEN.…”

Section: Crohn's Disease Exclusion Diet (Cded)mentioning

confidence: 98%

Nutritional Therapy Strategies in Pediatric Crohn’s Disease

et al. 2021

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The increase in incidences of pediatric Crohn’s Disease (CD) worldwide has been strongly linked with dietary shifts towards a Westernized diet, ultimately leading to altered gut microbiota and disturbance in intestinal immunity and the metabolome. Multiple clinical studies in children with CD have demonstrated the high efficacy of nutritional therapy with exclusive enteral nutrition (EEN) to induce remission with an excellent safety profile. However, EEN is poorly tolerated, limiting its compliance and clinical application. This has spiked an interest in the development of alternative and better-tolerated nutritional therapy strategies. Several nutritional therapies have now been designed not only to treat the nutritional deficiencies seen in children with active CD but also to correct dysbiosis and reduce intestinal inflammation. In this review, we report the most recent insights regarding nutritional strategies in children with active CD: EEN, partial enteral nutrition (PEN), Crohn’s disease exclusion diet (CDED), and CD treatment-with-eating diet (CD-TREAT). We describe their setup, efficacy, safety, and (dis)advantages as well as some of their potential mechanisms of action and perspectives. A better understanding of different nutritional therapeutic options and their mechanisms will yield better and safer management strategies for children with CD and may address the barriers and limitations of current strategies in children.

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Section: Crohn's Disease Exclusion Diet (Cded)mentioning

confidence: 98%

Nutritional Therapy Strategies in Pediatric Crohn’s Disease

et al. 2021

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“…Despite the absence of evidence about the exact duration of an EEN regimen, the guidelines recommend a minimum of 6 weeks. Indeed, while symptoms may improve after few days and by week 3 in most cases [ 61 ], mucosal healing takes several weeks to occur. Food re-introduction is then performed over a period of 1 to 5 weeks, although no protocols for the proper management are currently available [ 36 ].…”

Section: Nutritional Strategies In Induction Of Remission In Pediamentioning

confidence: 99%

Diet and Nutrition in Pediatric Inflammatory Bowel Diseases

2021

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Both genetic and environmental factors are involved in the onset of inflammatory bowel disease (IBD). In particular, diet composition is suspected to significantly contribute to IBD risk. In recent years, major interest has raised about the role of nutrition in disease pathogenesis and course, and many studies have shown a clear link between diet composition and intestinal permeability impairment. Moreover, many IBD-related factors, such as poor dietary intake, nutrients loss and drugs interact with nutritional status, thus paving the way for the development of many therapeutic strategies in which nutrition represents the cornerstone, either as first-line therapy or as reversing nutritional deficiencies and malnutrition in IBD patients. Exclusive enteral nutrition (EEN) is the most rigorously supported dietary intervention for the treatment of Crohn’s Disease (CD), but is burdened by a low tolerability, especially in pediatric patients. Promising alternative regimens are represented by Crohn’s Disease Exclusion Diet (CDED), and other elimination diets, whose use is gradually spreading. The aim of the current paper is to provide a comprehensive and updated overview on the latest evidence about the role of nutrition and diet in pediatric IBD, focusing on the different nutritional interventions available for the management of the disease.

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“…Additionally, the authors reported that CDED plus PEN was better tolerated than EEN (tolerance rates: 97.5% vs. 73.6%, p = 0.002). Furthermore, in a subsequent analysis of the abovementioned RCT, it was demonstrated that CDED + PEN was able to induce a rapid clinical response (at week 3), thus possibly identifying predictors of being in clinical remission at week 6 [ 196 ].…”

Section: Nutritional Therapiesmentioning

confidence: 99%

Dietary Management in Pediatric Patients with Crohn’s Disease

Scarallo

Lionetti

2021

Nutrients

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It has been widely endorsed that a multifactorial etiology, including interaction between genetic and environmental factors, can contribute to Crohn’s Disease (CD) pathogenesis. More specifically, diet has proven to be able to shape gut microbiota composition and thus is suspected to play a significant role in inflammatory bowel disease (IBD) pathogenesis. Moreover, poor nutritional status and growth retardation, arising from several factors such as reduced dietary intake or nutrient leakage from the gastrointestinal tract, represent the hallmarks of pediatric CD. For these reasons, multiple research lines have recently focused on the utilization of dietary therapies for the management of CD, aiming to target concurrently mucosal inflammation, intestinal dysbiosis and optimization of nutritional status. The forerunner of such interventions is represented by exclusive enteral nutrition (EEN), a robustly supported nutritional therapy; however, it is burdened by monotony and low tolerance in the long term. Novel dietary interventions, such as Crohn’s Disease Exclusion Diet or Crohn’s Disease treatment with eating, have shown their efficacy in the induction of remission in pediatric patients with CD. The aim of the present narrative review is to provide a synopsis of the available nutritional strategies in the management of pediatric CD and to discuss their application in the dietary management of these patients.

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Dietary Therapies Induce Rapid Response and Remission in Pediatric Patients With Active Crohn’s Disease

Cited by 56 publications

References 22 publications

Nutritional Therapy Strategies in Pediatric Crohn’s Disease

Nutritional Therapy Strategies in Pediatric Crohn’s Disease

Diet and Nutrition in Pediatric Inflammatory Bowel Diseases

Dietary Management in Pediatric Patients with Crohn’s Disease

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