Dietary therapy plus medical therapy may better improve outcomes in IBD
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A presentation at the Crohn’s and Colitis Congress, highlighted recent updates on dietary therapy for inflammatory bowel disease.
Arie Levine, MD, professor, Edith Wolfson Medical Center Pediatric Gastroenterology Unit at Tel Aviv University in Israel, spoke about recent updates regarding the Crohn’s Disease Exclusion Diet for patients with CD and the low FODMAP diet for irritable bowel syndrome symptoms in patients with IBD.
“CDED does meet all the clinical goals in definition of a second-generation therapy,” Levine said during his presentation. “It induces clinical remission, decreases inflammation, does no harm and induces mucosal healing. But offering dietary therapy in addition to medical therapy might improve our patients’ outcomes down the line.”
Levine and colleagues conducted a trial in which they randomly assigned children with CD to either CDED plus partial enteral nutrition or the “gold standard” dietary therapy, exclusive enteral nutrition. Tolerance served as the primary endpoint. Results were published in Gastroenterology.
Data showed CDED was very “well tolerated.” While 97.5% of patients from the CDED group were compliant, the exclusive enteral nutrition diet was considered hard to maintain.
Eighty percent of patients with active disease in the CDED group went into remission vs. 73.5% in the exclusive enteral nutrition group.
Levine and colleagues conducted a similar trial in adults with CD. In this study, 62.5% of adults in the CDED diet group went into remission, saw a significant decrease in endoscopic inflammation and a good rate of mucosal healing.
Additionally, Levine discussed a randomized trial of the low FODMAP diet intended for IBS symptoms in patients with IBD. Investigators assigned patients to either the low FODMAP diet or sham diet.
“The greatest effect was seen on bloating and flatulence and there was almost no effect on abdominal pain,” he said. “There wasn’t an effect on diarrhea. There was improvement on stool frequency.”
According to Levine, the primary endpoint of the IBS symptom severity score was not met; however, 50% of the FODMAP diet group reported adequate symptom relief compared with 25% of the sham diet group.
Levine concluded, “We’d like our therapies to prevent complications and reduce surgery though that seems to be a high bar at the present time. Let’s hope for a therapy in the future that might lead to a cure.”
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Levine A, et al. Latest Update in Diet Therapy for IBD: Crohn’s Disease Exclusion Diet and Low FODMAP Diet. Presented at: Crohn’s and Colitis Congress (virtual); Feb. 21-24, 2021.
Levine A, et al. Gastroenterol. 2019;doi:10.1053/j.gastro.2019.04.021.
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