Exclusive enteral nutrition: clues to the pathogenesis of Crohn's disease

Crohn's disease (CD) is a complex inherited disorder of unknown pathogenesis. Recent evidence suggests that CD may involve genetic or environmental factors that impair the normal innate immune system's ability to contain bacteria to the lumen. Multiple dietary components may impact on the resident flora, diminish or damage the mucous layer, increase intestinal permeability or increase the ability of pathobionts to adhere to epithelial cells or translocate across the epithelial barrier. This chapter reviews the possible effects of different dietary components present in the Western diet to affect bacterial clearance mechanisms, and offers a hypothetical model for an acquired bacterial clearance defect in CD.