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Complementary, alternative, integrative and dietary therapies for children with Crohn's disease - A systematic review
M Schwermer1, K Fetz2, A Längler1
1Department of Pediatrics, Gemeinschaftskrankenhaus Herdecke, Germany, Professorship for Integrative Pediatrics, Institute for Integrative Medicine, Witten/Herdecke University, Germany.
Insights
Dietary interventions like enteral nutrition and omega-3 fatty acids show promise as effective alternatives to corticosteroids for pediatric Crohn's disease, reducing side effects in children. Further research is needed for complementary therapies.
Area of Science:
- Pediatric Gastroenterology
- Clinical Nutrition
- Inflammatory Bowel Disease Research
Background:
- Pediatric Crohn's disease (CD) presents chronic challenges, including psychological stress and growth-impeding corticosteroid side effects.
- Alternative therapies are sought to mitigate treatment burdens in pediatric CD patients.
- Elemental and other dietary interventions are recognized options for managing pediatric CD.
Purpose of the Study:
- To systematically review controlled studies on dietary therapies for pediatric Crohn's disease.
- To assess the efficacy and safety of alternative treatments compared to standard therapies.
- To identify research gaps in complementary and alternative medicine (CAM) for pediatric CD.
Main Methods:
- Systematic literature search of multiple databases (Cochrane, EMBASE, PubMed, etc.) from inception to December 2019.
- Inclusion of randomized controlled trials (RCTs) and controlled trials evaluating dietary interventions.
- Analysis of studies on elemental, semi-elemental, polymeric diets, whole protein formulas, and ω-3 fatty acids.
Main Results:
- Seven studies met criteria, including six RCTs and one controlled trial.
- Dietary therapies (enteral diets, ω-3 fatty acids) demonstrated efficacy comparable or superior to corticosteroids in pediatric CD.
- No controlled studies were found for complementary, alternative, and integrative medicine (CAIM) approaches.
Conclusions:
- Enteral diets and ω-3 fatty acid supplementation represent a viable, potentially less aggressive alternative to corticosteroids for pediatric Crohn's disease.
- Current evidence on CAIM for pediatric CD is lacking, necessitating further clinical trials.
- More research is required to establish the risks and benefits of CAIM in pediatric CD management.
Abstract:
Children with diagnosed inflammatory bowel diseases such as Crohn's disease are faced with the daunting prospect of living with a chronic disease. Besides psychological stress, children are suffering from therapy side-effects; in particular, corticosteroid therapies are problematic in the growth phase. This highlights that there is a need for less aggressive alternative therapies for children as well as adolescents living with such chronic conditions. Elemental diets are widely used and accepted therapy options. Several pediatric Crohn's disease patients also use complementary, alternative and integrative therapies to reduce or avoid drug therapies. To survey such therapy options and their efficiency and safety, we performed a systematic literature search and screened databases (Cochrane Library, EMBASE, OvidSP, PubMed, CAMbase, CAM-QUEST, Anthromedics) from their inception to December 2019. In total, seven of 1439 studies fulfilled search criteria. Six RCTs and one retrospective controlled trial investigating elemental diets (Flexical, Elemental 028), semi-elemental diets (Pregomin), polymeric diets (Modulen IBD), whole protein based formulas, and ω-3 fatty acid supplementation were found. Data indicated that diet therapies were equal to or more effective than corticosteroid therapies when used to treat Crohn's disease. Regrettably, we could not identify controlled studies investigating complementary, alternative and integrative medicine approaches. Our review provides an updated overview of controlled studies investigating dietary therapies used in the treatment of pediatric Crohn's disease, and demonstrates that the current study situation does not reflect the actual use of complementary, alternative and integrative therapies. Therefore, clinical trials are necessary to estimate risks and benefits of such therapies. The review indicated that enteral diets and ω-3 fatty acid supplementation may be an effective alternative to corticosteroid treatments for children with Chron's disease.
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