A Levine et al. Gastroenterol 2019; 157: 440-50. This study found that a Crohn’s Disease Exclusion Diet plus partial enteral nutrition induced sustained remission in a 12-week prospective randomized controlled trial with 74 children. At week 12, “76% of 37 children given CDED plus PEN were in corticosteroid-free remission compared with 14 (45.1%) of 31 children given” EEN followed by PEN. The associated editorial on pages 295-6 provides a useful diagram of various dietary therapy components for a large number of diets that have been given for IBD. The editorial recommends:
“For now, simple dietetic recommendations such as consuming a well-balanced diet prepared largely from fresh ingredients and thereby avoidance of emulsifiers and additives and processed foods are appropriate for all patients. In select patients,…a trial of dietary therapy alone with a diet such as CDED could be attempted for a short period of time, with close follow-up, and with agreement with the patient that failure to fully respond is an indication to escalate therapy.” More dietary trials are ongoing.
Related blog posts:
- CD-TREAT Diet: Pushing the Boundaries on Diets for Crohn’s Disease
- Crohn’s Disease with Isolated Colonic Involvement Less Responsive to EEN
- Practical Advice on Enteral Nutrition | gutsandgrowth
- Head-to-Head: Enteral Nutrition vs. anti-TNF
- Gut Microbiome, Crohn’s Disease and Effect of Diet …
- The Search for a Dietary Culprit in IBD | gutsandgrowth
- Top Lecture: Enteral Nutrition for Crohn’s Disease …
- There is No Healthy Microbiome
- Why Does Enteral Nutrition Work for Crohn’s Disease? Is it due to the Microbiome?
NJ Samadder et al Clin Gastroenterol Hepatol 2019; 17: 1807-13. In this cohort from Utah 1996-2011 with 9505 individuals with IBD, 101 developed colorectal cancer. Standardized incidence ratio (SIR) for CRC in patients with Crohn’s disease was 3.4, in ulcerative colitis 5.2, in patients with primary sclerosing cholangitis 14.8. A family history of CRC increased the risk of CRC in patients with IBD to 7.9 compared to general population. Family hx/o CRC increased the SIR by about double the CRC risk in IBD patients without a family hx/o CRC.
CR Ballengee et al. Clin Gastroenterol Hepatol 2019; 17: 1799-1806. In this study with 161 subjects from the RISK cohort, the authors found that elevated CLO3A1 levels in subjects with CD was associated with the development of stricturing disease but was not elevated in those with strictures at presentation and in those who did not develop strictures.
AL Lightner et al IBD 2019; 25: 1152-68. Short- and Long-term Outcomes After Ileal Pouch Anal Anastomosis in Pediatric Patients: A Systematic Review. This review included 42 papers.
- Rates of superficial surgical site infection, pelvic sepsis, and small bowel obstruction at <30 days were 10%, 11%, and 14% respectively.
- Rates of pouchitis, stricture, chronic fistula, incontinence and pouch failure were 30%, 17%, 12%, 20% and 8% respectively with followup between 37-109 months.
- Mean 24-hour stool frequency was 5.
MC Choy et al IBD 2019; 25: 1169-86. Systematic review and meta-analysis: Optimal salvage therapy in acute severe ulcerative colitis. Among 41 cohorts (n=2158 cases) with infliximab salvage, overall colectomy-free survival was 69.8% at 12 months. The authors could not identify an advantage of dose-intensification in outcomes, though this was used more often in patients with increased disease severity, “which may have confounded the results.”