Gastroenterologie
a hepatologie

Current scientific background of Crohn’s Disease Exclusion Diet (CDED)

Nabil El-Lababidi¹

+ Affiliation
¹ Centrum dětské gastroenterologie, hepatologie a výživy, Klinika dětského a dorostového lékařství 1. LF UK a VFN v Praze

Summary

According to current European Crohn’s and Colitis Organisation (ECCO) and European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) joint guidelines, exclusive enteral nutrition (EEN) is the method of choice for the induction of remission of luminal Crohn’s disease (CD) in paediatric patients. The main limitations of EEN are its monotony and palatability. Factors of the Western diet that could cause gut dysbio­sis, dysregulation of immune mechanisms and induce inflammation in the intestinal mucosa have been identified. Eliminating these dietary factors should induce remission of CD. Crohn’s disease exclusion diet (CDED) is based on that principle. The data show that in the 6^th week of treatment, CDED with partial enteral nutrition (PEN) is equally effective but better tolerated than EEN. The induction and maintenance of remission in the 12^th week of therapy is statistically significantly better when using CDED with PEN. CDED is a very promising concept in the induction of remission of mild to moderate intraluminal CD.

Key words: Crohn’s disease – Crohn’s disease exclusion diet – adherence – gut microbio­ta

Keywords

Crohn’s disease, Crohn’s Disease Exclusion Diet (CDED), adherence, střevní mikrobiota

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Literature

1. Feuerstein JD, Cheifetz AS. Crohn disease: epidemiology, dia­gnosis, and management. Mayo Clinic Proc 2017; 92 (7): 1088–1103. doi: 10.1016/j.mayocp.2017.04.010.

2. Ruemmele FM, Veres G, Kolho KL et al. Consensus guidelines of ECCO/ESPGHAN on the medical management of pediatric Crohn’s dis­ease. J Crohns Colitis 2014; 8: 1179–1207. doi: 10.1016/j.crohns.2014.04.005.

3. Sartor R. Mechanisms of Disease: pathogenesis of Crohn’s disease and ulcerative colitis. Nat Rev Gastroenterol Hepatol 2006; 3: 390–407.

4. Sommer F, Rühlemann MC, Bang C et al. Microbio­markers in inflammatory bowel dis­ease. Gut 2017; 67 (9): 734–1738. doi: 10.1136/gutjnl-2016-313678.

5. 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/s12519-018-0204-0.

6. 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.

7. 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. doi: 10.1053/j.gastro.2019.04.021.

8. 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.

9. 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.

10. 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; 217: 14. doi: 10.1186/s12876-016-0564-7.

11. 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.

12. 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): p e22.e29. doi: 10.1097/MPG.00000 00000001946.

13. Miele E, Shamir R, Aloi M et al. Nutrition in paediatric inflammatory bowel dis­ease: a position paper on behalf of the Porto IBD Group of the ESPGHAN. J Pediatr Gastroenterol Nutr 2018; 66 (4): 687–708. doi: 10.1097/MPG.000000 0000001896.

14. Lee D, Albenberg L, Compher C et al. Diet in the pathogenesis and treatment of inflammatory bowel diseases. Gastroenterology 2015; 148 (6): 1087–106. doi: 10.1053/j.gastro.2015.01.007.

15. 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: 9032. doi: 10.1038/srep19032.

16. 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.

17. 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.

18. 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.

19. Tomas J, Mulet C, Saffarian A et al. High-fat diet modifies PPAR- g pathway leading to dis­ruption of microbial and physiological ecosystem in murine small intestine. Proc Natl Acad Sci USA 2016; 113 (40): E5934–E5943.

20. Wagner SJ, Schmidt A, Effenberger MJ et al. Semisynthetic diet ameliorates Crohn’s disease-like ileitis in TNFDARE/WT mice through antigen-independent mechanisms of gluten. Inflamm Bowel Dis 2013; 19 (6): 1285–1294.

21. 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.

22. 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/gutjnl-2016-313099.

23. 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.

24. 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.

25. 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.

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.