Single-center experience of the Crohn's disease exclusion diet in the United States: A retrospective study

The Crohn's Disease Exclusion Diet (CDED) offers a dietary means of inducing and maintaining remission for patients with Crohn's disease (CD). Descriptions of efficacy have emerged primarily from Israel, Europe, and Canada. Here, we offer real-world experience, from a tertiary care center in the United States.

We conducted a retrospective chart review of patients receiving education on the CDED and those adopting the diet. Demographics, medication exposure, disease-related complications, and reported side effects were collected. Corticosteroid-free clinical remission (SF-CR) was measured at weeks 6, 12, and 24 via the pediatric Crohn's Disease Activity Index (PCDAI). Biomarkers were collected at baseline and while on the diet.

Only 8% (n = 32) of children with CD had met with a dietitian regarding the CDED. Of those, 75% (n = 24) adopted the diet. A statistically significant change in PCDAI from baseline to weeks 6, 12, and 24 (χ²(3) = 9.61, P = 0.02) was observed. At 24 weeks, SF-CR was achieved in 9/11 subjects who remained on the diet, with a significant decrease in fecal calprotectin (Wilcoxon signed-rank test p < 0.01, 95% CI). In seven subjects with pre/post endoscopic assessment, endoscopic response was demonstrated in 71%. Side effects were mild and included increased abdominal pain, diarrhea, and weight loss (37.5%, n = 9).

In this single-center experience of children with mild to moderate CD who adopted the CDED, adherence was a challenge. However, for those who were able to sustain the diet, the CDED offered a safe and effective means of clinical remission.