Modified Crohn's disease exclusion diet is equally effective as exclusive enteral nutrition: Real‐world data

Abstract

Background: Data on the efficacy of the newly established dietetic treatment of Crohn's disease (CD), the CD exclusion diet (CDED), are scarce. The aim of this study was to provide real-world data on the efficacy of CDED in comparison with exclusive enteral nutrition (EEN) for remission induction. Methods:A retrospective analysis of children diagnosed with CD who were treated with CDED + partial EN (PEN) or with EEN was performed. Eighty percent of the children assigned to CDED + PEN underwent 1-2 weeks of EEN prior to CDED + PEN. For all children, data from the medical charts were extracted before the introduction of diet therapy and at the end of EEN or CDED + PEN phase 1.Results: A total of 61 patients (49.2% females; median age, 14.4 years [minimum: 6.7, maximum: 17.9]) were included in the study; 42 children (68.9%) achieved remission, 27 of 41 (65.9%) received EEN and 15 of 20 (75.0%) received CDED + PEN. There was no significant difference in the failure of nutrition therapy between the two groups (P = .469). Patients receiving CDED + PEN had significantly higher weight gain (P = .002) and increases in body mass index z-score (P = .001) compared with patients who received EEN alone. Conclusion:Treatment with CDED + PEN (with prior 1-2 weeks of EEN) has comparable efficacy to EEN therapy alone in inducing remission in children with CD, and it leads to better weight gain. Further studies are needed to confirm these results.

Diet fuelling inflammatory bowel diseases: preclinical and clinical concepts

“…Collectively, these early clinical trials provide evidence that the diet impacts gut inflammation in mild-to-moderate CD and UC, and real-world experience suggested that dietary approaches are efficacious beyond clinical trials. 131 The strengths of dietary therapy would be the easy access across the world, the low cost (probably 10%–30% compared with biologics in the first year) and, most importantly, avoidance of immunosuppression. Nutritional trials are also informative as they potentially allow to identify culprits of gut inflammation in IBD, as exemplified by reintroduction of meat and cereals which was associated with increased faecal calprotectin concentration after EEN in paediatric CD.…”

Dietary Patterns and Gut Microbiota Changes in Inflammatory Bowel Disease: Current Insights and Future Challenges

“…A retrospective analysis was performed to assess the efficacy of CDED in comparison with EEN for remission induction. A total of 42 children (68.9%) achieved remission in a total of 61 patients; 27 of 41 (65.9%) received EEN and 15 of 20 (75%) received CDED plus PEN (with prior 1–2 weeks of EEN) [ 89 ]. Furthermore, they found that patients with the CDED plus PEN regimen gained more weight compared to patients with EEN alone.…”

Nutritional Therapies and Their Influence on the Intestinal Microbiome in Pediatric Inflammatory Bowel Disease

“…Despite this, PEN has been used successfully to maintain clinical remission in CD [ 45 , 66 , 67 , 90 , 91 , 92 , 93 , 94 , 95 , 96 ]. Additionally, patients on PEN show improvements in nutritional status, defined by improved weight gain, linear growth and levels of micronutrients such as vitamins A, B12, D and E and minerals [ 92 , 93 , 94 , 96 , 97 ].…”

“…Despite this, PEN has been used successfully to maintain clinical remission in CD [ 45 , 66 , 67 , 90 , 91 , 92 , 93 , 94 , 95 , 96 ]. Additionally, patients on PEN show improvements in nutritional status, defined by improved weight gain, linear growth and levels of micronutrients such as vitamins A, B12, D and E and minerals [ 92 , 93 , 94 , 96 , 97 ]. A systematic review ( n = 429) of prospective studies assessing the effectiveness of PEN for maintenance of remission in CD demonstrated that PEN was superior at preventing clinical relapse (RR 0.67, 95% CI: 0.54–0.82, p < 0.01) and achieving clinical remission (RR 1.32, 95% CI: 1.07–1.64; p = 0.01) than those not receiving nutritional therapy [ 68 ].…”