CD exclusion diet induces, maintains remission in Crohn’s
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The Crohn’s disease exclusion diet with or without enteral nutrition induced and maintained remission in adult patients with mild to moderate CD and may lead to full endoscopic remission.
“The current goal of medical therapy is to reduce inflammation and induce mucosal healing, which can be achieved by modifying immune pathways; however, many of the drugs used to manage Crohn’s disease involve immune suppression and have additional side effects,” Henit Yanai, MD, of Rabin Medical Center in Petah Tikva, Israel, and colleagues wrote in Lancet Gastroenterology and Hepatology. “An unmet need exists for safer therapies, particularly in patients with milder disease activity at lower risk for complicated disease, or those who have a condition precluding immune suppression. Dietary factors are among the strongest candidates for environmental factors that might drive inflammation.”
Using whole food with partial enteral nutrition, the CD exclusion diet (CDED) is a novel dietary therapy aimed to achieve remission and reduce inflammation among patients with CD. Children studied showed this approach may be just as effective as exclusive enteral nutrition but with better compliance; no data exists among an adult cohort.
In an open-label, pilot randomized trial, researchers analyzed 44 patients (median age, 30 years) with CD through 24 weeks to assess the feasibility and effectiveness of CDED on induction and maintenance of remission and compliance, as well as compare improved outcomes between CDED plus partial enteral nutrition (n = 20) vs. CDED alone (n = 24).
According to study results, following dietary intervention at week 6, 63% (n = 25) of patients achieved clinical remission. Differences between the groups at week 6 — 68% (n = 13) of patients in the CDED with partial enteral nutrition group and 57% (n = 12) in the CDED alone group — were not significant. Of those patients in remission at week 6, 88% (n = 22) sustained remission at week 12 and 80% (n = 20) sustained remission at week 24. Of these patients, there were no significant differences between the two groups at weeks 12 (63% vs. 48%, respectively) or 24 (63% vs. 38%).
Further analysis revealed endoscopic remission at week 24 occurred in 35% (n = 14) of patients. The differences between groups — eight patients in the CDED with partial enteral nutrition group and six patients in the CDED alone group — were not significant.
Researchers noted no serious or treatment-related adverse events.
“This diet could be used in adults with uncomplicated mild-to-moderate Crohn’s disease at diagnosis and possibly serve as a therapeutic alternative for patients who cannot receive medical therapy due to underlying health conditions,” Yanai and colleagues concluded. “Our findings suggest that the CDED alone or CDED with partial enteral nutrition should be explored further in powered randomized controlled trials.”
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