Beyond the "ideal" candidate: The Crohn's disease exclusion diet's potential in perianal disease - a case report

Dietary therapies for the management of Crohn's Disease (CD) have recently attracted increasing attention. This is the first thoroughly discussed case documenting the use of the Crohn's Disease Exclusion Diet (CDED) specifically in a patient with perianal CD. We report on clinical and anthropometric outcomes and self-reported Quality of life (QoL) after CDED plus Partial Enteral Nutrition (PEN) administration in an adult with active perianal CD.

"J" is a 31-year-old man with a history of surgically treated ileocolonic penetrating CD diagnosed at age 20 (A2L3B3p), treated with intensified Infliximab (IFX) dose for three years. The patient experienced relapses with increased bowel movements and fistula discharge in all de-escalation efforts across these years. The multi-phase CDED coupled with PEN was initiated as an adjunctive therapy.

After 12 weeks of dietary therapy, the patient reached the lowest biochemical markers of inflammation within the three years of intensified IFX therapy. Remarkably, his fistula drainage all but disappeared. At confirmation of endoscopic improvement, the patient's stable clinical and biochemical situation triggered a de-escalation of IFX dose interval from 4 to 6 and finally to 8 weeks and the seton removal. Two years after the initiation of the CDED protocol, the patient has not experienced any clinical flare up requiring hospitalization or addition of any further drug therapy, is clinically stable and consistently follows the CDED maintenance phase diet.

This report highlights initial evidence supporting CDED as a potential complementary option in managing perianal CD.