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Gastroenterologie
a hepatologie

Gastroenterology and Hepatology

Gastroent Hepatol 2023; 77(2): 140–144. doi: 10.48095/ccgh2023140.

International experience with Crohn’s disease exclusion diet (CDED) with partial enteral nutrition (PEN)

Nabil El-Lababidi1

+ Affiliation

Summary

The role of dietary intervention in the induction of remission of Crohn’s disease (CD) has been confirmed again by the recent ECCO (European Crohn’s and Colitis Organization) and ESPGHAN (European Society for Paediatric Gastroenterology, Hepatology and Nutrition) guidelines. Exclusive enteral nutrition (EEN) should be the method of choice in induction of remission of active luminal CD in children. Steroids should be reserved for situations when intolerance or infectivity of EEN is present. The main limitations of EEN consist of its monotony and palatability. In search for a safe and at least similarly effective diet, Crohn’s disease exclusion diet (CDED) was developed. The number of published data regarding its safety and efficacy has increased significantly since the publication of the first randomized controlled trial in 2019. CDED seems, to be safe and its efficacy is very promising. It seems that CDED could be used in three scenarios: as a monotherapy, as a part of complex treatment and as rescue therapy in cases of loss of response. The use of CDED is promising but further research for evaluation of its efficacy, including the necessity of using partial enteral nutrition, on larger patient cohorts is required.

Keywords

Crohn’s disease, exclusive enteral nutrition, steroids, Crohn’s Disease Exclusion Diet (CDED), adherence

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Literature

1. van Rheenen PF, Aloi M, Assa A et al. The Medical Management of Paediatric Crohn’s Disease: an ECCO-ESPGHAN Guideline Update. J Crohns Colitis 2021; 171–194. doi: 10.1093/ecco-jcc/jjaa161.
2. Narula N, Dhillon A, Zhang D et al. Enteral nutritional therapy for induction of remission in Crohn’s disease. Cochrane Database of Syst Rev 2018; 4(4): CD000542. doi: 10.1002/14651858.CD000542.pub3.
3. Swaminath A, Feathers A, Ananthakrishan A et al. Systemic Review with Meta-Analysis: Enteral Nutrition Therapy for the Induction of Remission in Paediatric Crohn’s Disease. Aliment Pharmacol Ther 2017; 46(7): 645–656. doi: 10.1111/apt.14253.
4. Yu Y, Chen KC, Chen J. Exclusive enteral nutrition versus corticosteroids for treatment of pediatric Crohn’s disease: a meta-analysis. World J Pediatr 2019; 15(1): 26–36. doi: 10.1007/s125 19-018-0204-0.
5. Miller T, Suskind DL. Exclusive enteral nutrition in pediatric inflammatory bowel disease. Curr Opin Pediatr 2018; 30(5): 671–676. doi: 10.1097/MOP.0000000000000660.
6. Costello R, Patel R, Humphreys J et al. Patient perceptions of glucocorticoid side effects: a cross-sectional survey of users in an online health community. BMJ Open 2017; 7(4): e014603. doi: 10.1136/bmjopen-2016-014603.
7. Singh S, Facciorusso A, Dulai PS et al. Comparative Risk of Serious Infections with Biologic and/or Immunosuppressive Therapy in Patients with Inflammatory Bowel Diseases: A Systematic Review and Meta-Analysis. Clin Gastroenterol Hepatol 2020; 18(1): 69–81.e3. doi: 10.1016/j.cgh.2019.02.044.
8. da Silva JS, Seres DS, Sabin K et al. ASPEN Consensus Recommendations for Refeeding Syndrome. Nutr Clin Pract 2020; 35(2): 178–195. doi: 10.1002/ncp.10474.
9. Wall CL, Gearry RB, Day AS. Treatment of Active Crohn’s Disease with Exclusive and Partial Enteral Nutrition: A Pilot Study in Adults. Inflamm Intest Dis 2018; 2(4): 219–227. doi: 10.1159/000489630.
10. Wall CL, Gearry RB, Day AS. New Zealand gastroenterologists’ perceptions, knowledge and experience of exclusive enteral nutrition to treat Crohn’s disease. N Z Med J 2017; 2130(1464): 77–79.
11. Svolos V, Gerasimidis K, Buchanan E et al. Dietary treatment of Crohn’s disease: perception of families with children treated by exclusive enteral nutrition, a questionnaire survey. BMC Gastroenterol 2017; 17(1): 14. doi: 10.1186/s12876-016-0564-7.
12. Shaikhkhalil AK, Boyle B, Smith J et al. Using Quality Improvement to Increase Utilization of Enteral Therapy in Pediatric Crohn Disease. J Pediatr Gastroenterol Nutr 2018; 66(6): 909–914. doi: 10.1097/MPG.0000000000001879.
13. Lowley M, Wu JW, Navas-López M et al. Global Variation in Use of Enteral Nutrition for Pediatric Crohn Disease. J Pediatr Gastroenterol Nutr 2018; 67(2): e22–e29. doi: 10.1097/MPG. 0000000000001946.
14. Levine A, Wine E, Assa A et al. Crohn’s Disease Exclusion Diet Plus Partial Enteral Nutrition Induces Sustained Remission in a Randomized Controlled Trial. Gastroenterology 2019; 157(2): 440–450.e8. doi: 10.1053/j.gastro.2019.04.021.
15. Ananthakrishnan AN, Khalil IH, Konijeti GG et al. A prospective study of long-term intake of dietary fiber and risk of Crohn’s disease and ulcerative colitis. Gastroenterology 2013; 145(5): 970–977. doi: 10.1053/j.gastro.2013.07.050.
16. Desai MS, Seekatz AM, Koropatkin NM et al. A Dietary Fiber-Deprived Gut Microbiota Degrades the Colonic Mucus Barrier and Enhances Pathogen Susceptibility. Cell 2016; 167(5): 1339–1353. doi: 10.1016/j.cell.2016.10.043.
17. Agus A, Denizot J, Thévenot J et al. Western diet induces a shift in microbiota composition enhancing susceptibility to Adherent-Invasive E. coli infection and intestinal inflammation. Sci Rep 2016; 6: 19032. doi: 10.1038/srep19032.
18. Martinez-Medina M, Denizot J, Dreux N et al Western diet induces dysbiosis with increased E coli in CEABAC10 mice, alters host barrier function favouring AIEC colonisation. Gut 2014; 63(1): 116–124. doi: 10.1136/gutjnl-2012-304119.
19. Wagner SJ, Schmidt A, Effenberger MJ et al. Semisynthetic diet ameliorates Crohn’s disease-like ileitis in TNFARE/WT mice through antigen-independent mechanisms of gluten. Inflamm Bowel Dis 2013; 19(6): 1285–1294. doi: 10.1097/MIB.0b13e318281f573.
20. Chassaing B, Koren O, Goodrich JK et al. Dietary emulsifiers impact the mouse gut microbiota promoting colitis and metabolic syndrome. Nature 2015; 519(7541): 92–96. doi: 10.1038/nature14232.
21. Chassaing B, Van de Wiele T, De Bodt J et al. Dietary emulsifiers directly alter human microbiota composition and gene expression ex vivo potentiating intestinal inflammation. Gut 2017; 66(8): 1414–1427. doi: 10.1136/gut jnl-2016-313099.
22. Nickerson KP, Chanin R, McDonald C. Dysregulation of intestinal anti-microbial defense by the dietary additive, maltodextrin. Gut Microbes 2015; 6(1): 78–83. doi: 10.1371/journal.pone.0101789.
23. Nickerson KP, Homer CR, Kessler SP et al. The dietary polysaccharide maltodextrin promotes Salmonella survival and mucosal colonization in mice. PLoS One 2014; 9(7): e101789. doi: 10.1371/journal.pone.0101789.
24. Fahoum L, Moscovici A, David S et al. Digestive fate of dietary carrageenan: Evidence of interference with digestive proteolysis and disruption of gut epithelial function. Mol Nutr Food Res 2017; 161(3). doi: 10.1002/mnfr.201600545.
25. El-Lababidi N. Aktuální vědecké podklady pro dietu pro Crohnovu chorobu založenou na vyloučení konkrétních potravin. Gastroenterol Hepatol 2020; 74(3): 240245. doi: 10.14735/amgh202040.
26. Sigall-Boneh R, Pfeffer-Gik T, Segal I et al. Partial Enteral Nutrition with a Crohn’s Disease Exclusion Diet is Effective for Induction of Remission in Children and Young Adults with Crohn’s Disease. Inflamm Bowel Dis 2014; 20: 1353–1360. doi: 10.1016/S1873-9946(14)50088-8.
27. Sigall-Boneh R, Sarbagili Shabat CS, Yanai H et al. Dietary Therapy with the Crohn’s Disease Exclusion Diet is a Successful Strategy for Induction of Remission in Children and Adults Failing Biological Therapy. J Crohns Colitis 2017; 11(10): 1205–1212. doi: 10.1093/ecco-jcc/jjx071.
28. Szczubelek M, Pomorska K, Korólczyk-Kowalczyk M et al. Effectivness of Crohn’s Disease Exclusion Diet for Induction of Remission in Crohn’s Disease Adult Patients. Nutrients 2021; 13(11): 4112. doi: 10.3390/nu13114112.
29. Scarallo L, Banci E, Pierattini V et al. Crohn’s disease exclusion diet in children with Cohn’s disease: a case series. Curr Med Res Opin 2021; 37(7): 1115–1120. doi: 10.1080/03007995. 2021.1920901.
30. Matuszczyk M, Meglicka M, Wiernicka A et al. Effect of the Crohn’s Disease Exclusion Diet (CDED) on the Decal Calprotectin Level in Children with Active Crohn’s Disease. J Clin Med 2022; 11(14): 4146. doi: 10.3390/jcm11144146.
31. Yanai H, Levine A, Hirsch A et al. The Crohn’s disease exclusion diet for induction and maintenance of remission in adults with mild-to-moderate Crohn’s disease (CDED-AD): an open-labeled, pilot, randomized trial. Lancet Gastroenterol Hepatol 2022; 7(1): 49–59. doi: 10.1016/S2468-1253(21)00299-5.
32. Levine A, El-Matary W, Van Limbergen J. A Case-Based Approach to New Directions in Dietary Therapy of Crohn’s Disease: Food for Thought. Nutrients 2020; 12(3): 880. doi: 10.3390/nu12030880.

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