Background: Exclusive enteral nutrition is effective for inducing remission in active pediatric Crohn's disease. Partial enteral nutrition (PEN) with free diet is ineffective for inducing remission, suggesting that the mechanism depends on exclusion of free diet. We developed an alternative diet based on PEN with exclusion of dietary components hypothesized to affect the microbiome or intestinal permeability.
Methods: Children and young adults with active disease defined as a pediatric Crohn's disease activity index >7.5 or Harvey–Bradshaw index ≥4 received a 6-week structured Crohn's disease exclusion diet that allowed access to specific foods and restricted exposure to all other foods, and up to 50% of dietary calories from a polymeric formula. Remission, C-reactive protien, and erythrocyte sedimentation rate were reevaluated at 6 weeks. The primary endpoint was remission at 6 weeks defined as Harvey–Bradshaw index ≤3 for all patients and pediatric Crohn's disease activity index <7.5 in children.
Results: We treated 47 patients (mean age, 16.1 ± 5.6 yr; 34 children). Response and remission were obtained in 37 (78.7%) and 33 (70.2%) patients, respectively. Mean pediatric Crohn's disease activity index decreased from 27.7 ± 9.4 to 5.4 ± 8 (P < 0.001), Harvey–Bradshaw index from 6.4 ± 2.7 to 1.8 ± 2.9 (P < 0.001). Remission was obtained in 70% of children and 69% of adults. Normalization of previously elevated CRP occurred in 21 of 30 (70%) patients in remission. Seven patients used the diet without PEN; 6 of 7 obtained remission.
Conclusions: Dietary therapy involving PEN with an exclusion diet seems to lead to high remission rates in early mild-to-moderate luminal Crohn's disease in children and young adults.
Article first published online 30 June 2014.
*Pediatric Gastroenterology Unit, Wolfson Medical Center,
†Epidemiology Unit, Wolfson Medical Center, and
‡Sackler School of Medicine, Tel Aviv University, Holon, Israel.
Reprints: Arie Levine, MD, Paediatric Gastroenterology Unit, Wolfson Medical Center, 62 Halohamim Str, Holon, Israel 58100 (e-mail: firstname.lastname@example.org).
R. Sigall-Boneh and T. Pfeffer-Gik are equal first authors. A. Levine has received a research grant from Nestle for an ongoing study involving the diet reported in this article. The remaining authors have no conflicts of interest to disclose.
Received April 30, 2014
Accepted May 11, 2014