Exclusion diet could be new first line treatment for paediatric Crohn’s disease

A novel Crohn’s Disease exclusion diet could replace Exclusive Enteral Nutrition (EEN) as first line treatment for children with mild-to-moderate active disease, a study suggests.

Based on the principles of reducing intake of saturated fat, wheat and emulsifiers, the diet has proved to be as effective as EEN and better tolerated in a Canadian-Israeli trial.

Developed by Dr Arie Levine and colleagues at the Edith Wolfson Medical Center, and Tel Aviv University, Israel, the exclusion diet was based on research showing that certain nutrients may contribute to dysbiosis and inflammation that ultimately cause Crohn’s disease (CD) in children.

They therefore developed an exclusion diet that reduced intake of animal and saturated fat, taurine, wheat, haem/iron, emulsifiers, maltodextrins, carageenans and sulphites while upping the consumption of fruit, vegetables and foods high in resistant starch.

The team compared the diet in conjunction with partial enteral nutrition (n=40) with exclusive enteral nutrition (n=34) over 12-weeks in children aged 4-18 years of age with recent onset of CD of mild to moderate severity, CRP >0.6 or ESR >20mm/h or calprotectin >200mg/ and paediatric CD activity index (PCDAI) of >10).

Presenting the results at ECCO 2019 in Copenhagen the researchers said that at six weeks, children on the CD exclusion diet showed better tolerance (97.5% vs 73.7%) and no significant difference in rates of compliance, response, remission (PCDAI <10 or <7.5) compared to those on exclusive enteral nutrition.

Both groups showed similar reductions in in PCDAI from a median of 25 to 2.5 with the exclusion diet and from 27.5 to 5 in the exclusive enteral nutrition group. Similar patterns in reductions in CRP were seen in both groups.

At week 12 the rates of sustained remission were 70.0% for the exclusion diet and 45.2% for the exclusive enteral nutrition. And for maintenance of remission from weeks 6 to 12, the rates were 87.5% for CD exclusion diet and 56.0% for EEN.

Median calprotectin levels also fell to a greater degree in the CD exclusion diet group compared to the exclusive enteral nutrition group.

Microbiome analysis showed  a decline in pro-inflammatory Proteobacteria and an expansion of Firmicutes in the CD exclusion diet group.

“These data involving an equivalent effect on remission but superior tolerance and sustained remission support using the Crohn’s disease exclusion diet with partial enteral nutrition for 12 weeks as a first line therapy to replace Exclusive Enteral Nutrition in mild to moderate luminal Crohn’s disease,” Dr Levine concluded.

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