Effectiveness of Crohn’s Disease Exclusion Diet for Induction of Remission in Crohn’s Disease Adult Patients

Abstract

Exclusive enteral nutrition (EEN) is a first-line treatment in active, mild to moderate Crohn’s disease (CD) in children. The Crohn’s disease exclusion diet (CDED), which avoids products known to have a pro-inflammatory effect on the intestinal mucosa, presents similar effectiveness to EEN for inducing remission in the paediatric population. The aim of the study was to evaluate the effectiveness of the CDED in inducing remission in adult patients. Between March 2020 and May 2021, 32 patients in a gastroenterology outpatient centre were treated according to the assumptions of the CDED. The patients were seen at baseline, at week 6, and at week 12 of the study. During the visits, anthropometric measurements and laboratory tests were performed, Crohn’s disease activity index (CDAI) was calculated, and the Inflammatory Bowel Disease Questionnaire (IBDQ) was completed. The study included a total of 32 participants, 18 women (56.3%) and 14 men (43.7%). Clinical remission was obtained in 76.7% patients after 6 weeks and in 82.1% after 12 weeks of therapy. Calprotectin levels were significantly lower in the second follow-up compared with baseline (p = 0.021). The CDED is an effective therapy for inducing remission in the adult CD population.

Effect of the Crohn’s Disease Exclusion Diet (CDED) on the Fecal Calprotectin Level in Children with Active Crohn’s Disease

“…In the patients under analysis, a 12-week treatment with CDED + PEN resulted in normalization of fecal calprotectin level in 35%, while 33% achieved such an effect in combination with normal CRP and PCDAI scores. Due to the lack of such data, it is not possible to compare these results with three previous publications concerning this treatment modality [ 32 , 34 , 35 ]. In the data from the literature on pharmacological treatment, the percentage of patients achieving mucosal healing after the period of induction therapy was several percent for steroids [ 36 ] and ranged from several to nearly 40% for biological treatment, according to the molecule used [ 37 ].…”

“…In addition, in the group treated with the CDED + PEN, in contrast to the control group, a reduction in intestinal permeability and the beneficial changes in the composition of microbiota [ 32 ] and in the metabolome [ 33 ] were shown, which may be important in the long-term maintenance of treatment effects. In the last year, the high efficacy of such nutritional therapy has been confirmed in the adult population [ 34 , 35 ].…”

Management of refractory inflammatory bowel disease

“…More recent data from a retrospective study in adults with active Crohn's disease showed that oral polymeric EEN was well tolerated and effective at inducing biochemical and clinical remission [41]. In addition, a recent study found that the Crohn's disease exclusion diet (CDED), which avoids products with a pro-inflammatory effect, resulted in 82.1% clinical remission at 12 weeks and significantly lower calprotectin levels compared with the baseline [42 ▪ ].…”

"Out of the box� new therapeutic strategies for Crohn�s disease: moving beyond biologics

“…The authors concluded that CDED is an effective therapy for inducing remission in the adult CD population (78). In another adult CD cohort, Yanai et al performed an open-label, pilot randomised, where eligible patients were biologic naïve adults with mild-to-moderate disease, randomly assigned to CDED plus PEN or CDED alone for 24 weeks.…”