Dietary therapy with the Crohn's disease exclusion diet is a successful strategy for induction of Remission in children and adults failing biological therapy

Rotem Sigall Boneh, Chen Sarbagili Shabat, Henit Yanai, Irit Chermesh, Sivan Ben Avraham, Mona Boaz, Arie Levine

Research output: Contribution to journalArticlepeer-review

142 Scopus citations

Abstract

Background: Loss of response [LoR] to biologics in Crohn's disease [CD] is a significant clinical problem. Dietary therapy as a treatment strategy in this setting has not been previously reported. We report the use of dietary strategies using enteral nutrition coupled with the Crohn's Disease Exclusion Diet [CDED] for LoR to infliximab or adalimumab as a single-centre experience. Methods: Patients with LoR to a biologic despite dose escalation or combination therapy were treated with partial enteral nutrition [PEN] by a polymeric formula and the CDED for 12 weeks. Paediatric patients with severe flares received 14 days of exclusive enteral nutrition followed by PEN + CDED as above. All patients were seen at weeks 6 and 12 for follow up. Current and prior treatment, Harvey Bradshaw Index [HBI], C-reactive protein [CRP] and albumin were recorded. Remission was defined as HBI < 5 at week 6. Results: Twenty-one patients, mean age 22.1 ± 8.9 years [11 adults and ten children] met study criteria. Seventeen patients [81%] had used combination therapy, and 10/21 [47.6%] had failed a second biologic. Seven patients had a prior intestinal resection. Dose escalation had failed in 13/21 [62%] patients. Clinical remission by physician's global assessment and HBI after 6 weeks was obtained in 13/21 [61.9%]. Mean HBI decreased from 9.4 ± 4.2 to 2.6 ± 3.8 [p < 0.001], mean CRP decreased from 2.8 ± 3.4 to 0.7 ± 0.5 [p = 0.005] and mean albumin increased from 3.5 ± 0.6 to 3.8 ± 0.5 [p = 0.06]. Conclusion: Dietary treatment combining PEN with the CDED may be a useful salvage regimen for patients failing biological therapy despite dose escalation.

Original languageEnglish
Pages (from-to)1205-1212
Number of pages8
JournalJournal of Crohn's and Colitis
Volume11
Issue number10
DOIs
StatePublished - 1 Oct 2017

Keywords

  • Adalimumab
  • Child
  • Crohn's disease
  • Diet
  • Infliximab

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