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Clinical and mucosal improvement with specific carbohydrate diet in pediatric Crohn disease
Stanley A Cohen1, Benjamin D Gold, Salvatore Oliva
1*Children's Center for Digestive Health Care †Children's Healthcare of Atlanta, Atlanta, GA ‡Department of Pediatrics, Pediatric Gastroenterology Unit, "La Sapienza" University of Rome, Rome, Italy §Given Imaging, Yoqneam, Israel.
Insights
The Specific Carbohydrate Diet (SCD) showed significant clinical and mucosal improvements in children with Crohn disease (CD). Capsule endoscopy (CE) effectively monitored these treatment effects in pediatric CD patients.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Dietary Interventions in Chronic Illness
Background:
- Crohn disease (CD) is a chronic inflammatory bowel disease affecting children.
- Current treatment options for pediatric CD have limitations.
- Dietary interventions are being explored as complementary therapies for CD.
Purpose of the Study:
- To prospectively evaluate the clinical and mucosal responses to the Specific Carbohydrate Diet (SCD) in pediatric patients with Crohn disease.
- To assess the utility of capsule endoscopy (CE) in monitoring treatment efficacy in this population.
Main Methods:
- Ten children with active CD (Pediatric Crohn's Disease Activity Index [PCDAI] ≥ 15) were enrolled.
- Patients received the SCD for up to 52 weeks while maintaining prescribed medications.
- Clinical data (PCDAI, Harvey-Bradshaw Index [HBI]) and capsule endoscopy (CE) findings (Lewis score [LS]) were collected at baseline, 12, and 52 weeks.
Main Results:
- Significant reductions in HBI (3.3 to 0.6, P=0.007) and PCDAI (21.1 to 7.8, P=0.011) were observed after 12 weeks on SCD.
- Lewis scores (LS) also significantly decreased (2153 to 960, P=0.012), indicating reduced inflammation.
- Sustained improvements in HBI and PCDAI were noted at 52 weeks, with 2 patients achieving mucosal healing.
Conclusions:
- The Specific Carbohydrate Diet (SCD) demonstrates efficacy in improving clinical symptoms and mucosal healing in children with Crohn disease.
- Capsule endoscopy (CE) serves as a valuable tool for monitoring mucosal healing in pediatric CD treatment trials.
- Further research is warranted to elucidate the mechanisms behind SCD's effectiveness in pediatric CD.
Objective:
The aim of the study was to prospectively evaluate clinical and mucosal responses to the specific carbohydrate diet (SCD) in children with Crohn disease (CD).
Methods:
Eligible patients with active CD (Pediatric Crohn's Disease Activity Index [PCDAI] ≥ 15) underwent a patency capsule and, if passed intact, capsule endoscopy (CE) was performed. Patients taking SCD were monitored for 52 weeks while maintaining all prescribed medications. Demographic, dietary, and clinical information, PCDAI, Harvey-Bradshaw Index (HBI), and Lewis score (LS) were collected at 0, 12, and 52 weeks. CEs were evaluated by an experienced reader blinded to patient clinical information and timing.
Results:
Sixteen patients were screened; 10 enrolled; and 9 completed the initial 12-week trial-receiving 85% of estimated caloric needs before, and 101% on the SCD. HB significantly decreased from 3.3 ± 2.0 to 0.6 ± 1.3 (P = 0.007) as did PCDAI (21.1 ± 5.9 to 7.8 ± 7.1, P = 0.011). LS declined significantly from 2153 ± 732 to 960 ± 433 (P = 0.012). Seven patients continued the SCD up to 52 weeks; HB (0.1 ± 0.4) and PCDAI (5.4 ± 5.5) remained improved (P = 0.016 and 0.027 compared to baseline), with mean LS at 1046 ± 372 and 2 patients showed sustained mucosal healing.
Conclusions:
Clinical and mucosal improvements were seen in children with CD, who used SCD for 12 and 52 weeks. In addition, CE can monitor mucosal improvement in treatment trials for pediatric CD. Further studies are critically needed to understand the mechanisms underlying SCD's effectiveness in children with CD.
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