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Pilot study of an elimination diet in adults with mild to moderate Crohn's disease
Neeraj Narula1, Emily C L Wong1, Paul Moayyedi1
1Department of Medicine, Division of Gastroenterology, Farncombe Family Digestive Health Research Institute; McMaster University, Hamilton, ON, Canada.
Insights
The McMaster Elimination Diet for Crohn's disease (MED-CD) showed potential in a pilot study. This dietary therapy, following initial enteral nutrition, was acceptable for most adult patients with Crohn's disease.
Area of Science:
- Gastroenterology
- Clinical Nutrition
- Inflammatory Bowel Disease
Background:
- Limited data exists on dietary therapy efficacy for adult Crohn's disease (CD).
- The McMaster Elimination Diet for CD (MED-CD) excludes common Western diet ingredients.
- This pilot study investigated the MED-CD in adults with mild-to-moderately active CD.
Purpose of the Study:
- To assess the efficacy and acceptability of the MED-CD in adults with Crohn's disease.
- To evaluate clinical and endoscopic outcomes following a dietary intervention.
- To determine adherence rates to the MED-CD protocol.
Main Methods:
- A prospective study involving 17 adults with mild-to-moderately active CD.
- Initial 2-week oral enteral nutrition (EN) followed by 12-week MED-CD for responders.
- Outcomes included clinical remission (CR), clinical response, endoscopic response, endoscopic remission (ER), and adherence.
Main Results:
- 13 of 17 patients responded to EN and proceeded to MED-CD.
- Adherence to MED-CD was reported by 84.6% at week 6 and 67% at week 14.
- At week 14, 38.5% achieved CR, 46.2% showed endoscopic response, and 15.4% achieved ER.
Conclusions:
- Two weeks of EN followed by 12 weeks of MED-CD was acceptable for most adult CD patients.
- The MED-CD shows promise as a dietary therapy for managing Crohn's disease.
- Further research is warranted to confirm the long-term efficacy of MED-CD.
Background:
There remains limited data supporting the efficacy of dietary therapy in adults with Crohn's disease (CD). This was a pilot study of the McMaster Elimination diet for CD (MED-CD), which excludes several potentially detrimental ingredients commonly found in the Western diet.
Methods:
Prospective study in adults with mild-moderately active CD [Harvey-Bradshaw Index (HBI) scores 5-16] and endoscopic disease activity of >7 (or ≥4 for isolated ileal disease) as measured by the Simple Endoscopic Score for Crohn's disease (SES-CD). Patients were treated for 2 weeks using oral enteral nutrition (EN). Those with symptomatic improvement (HBI score reduction ≥2) were transitioned to the MED-CD for 12 weeks. Outcomes of interest included satisfactory adherence (≥20 on the modified medical adherence report scale-5 questionnaire), clinical remission (CR) (HBI ≤4), clinical response (HBI reduction ≥3), endoscopic response (SES-CD reduction ≥50%), and endoscopic remission (ER) (SES-CD <3).
Results:
A total of 17 patients were treated with 2 weeks of EN. Of these, 13 were deemed responders and treated with 12 weeks of MED-CD. Satisfactory adherence was reported among 11/13 (84.6%) at week 6 and 8/12 (67%) at week 14. Of the 13 patients who responded to EN by week 2, 5 (38.5%) had attained CR at week 2 and maintained CR until week 14 using MED-CD. Endoscopic response was observed in 6 (46.2%) participants and ER was seen in 2 (15.4%).
Conclusions:
Two weeks of oral EN followed by 12 weeks of the MED-CD was acceptable by most adult patients who enroled in this study.
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