Crohn's Disease Exclusion Diet for the Treatment of Crohn's Disease: Real-World Experience from a Tertiary Center

Abstract

The Crohn's Disease (CD) exclusion diet (CDED) has been shown to induce remission in pediatric and adult patients with CD. In this retrospective cohort study, we describe our real-world experience with the CDED at the inflammatory bowel disease (IBD) unit of the Tel Aviv Medical Center between 2018-2021. CD patients with multiple clinical presentations and disease phenotypes who initiated the diet were included. Indications for treatment, medical and nutritional data were collected from dietician clinic visits and medical records. Clinical and biomarker responses were determined. The CDED was recommended to 220 CD patients. Seventy-two patients were included in the analysis for a clinically active disease (n = 48) or for remission maintenance (n = 24). Among patients with a clinically active disease, 62.5% of patients achieved clinical remission at week 6 and at week 12. A positive association between high adherence to the CDED and clinical remission at week 12 was observed (adjusted OR = 7.6, 95% CI 1.07-55.2, p = 0.043). Among patients treated for remission maintenance, remission at week 12 was maintained among 83.3% of patients. We conclude that the CDED may be a promising intervention for multiple CD presentations and indications. These findings should be further validated in larger, prospective, controlled studies.

Keywords: Crohn’s disease; dietary therapy; exclusion diet.

Figure 1

Crohn’s disease study population flowchart. Legend: Active disease was defined as either clinical (HBI ≥ 5), biomarker (Fcal ≥ 250 mg/kg), or endoscopic disease activity (SES-CD ≥ 7 or Rutgeerts score ≥ i2). Abbreviations: CD—Crohn’s Disease, CDED—Crohn’s disease exclusion diet.

Figure 2

Clinical and biomarker improvement following the CDED. HBI improved significantly in patients who initiated the diet with a clinically active disease (A). Fcal improved significantly in patients who initiated the diet with Fcal ≥ 250 mg/kg (B). CRP improved significantly in patients who initiated the diet with CRP ≥ 0.5 mg/dl (C). ** p < 0.001. Abbreviations: CRP—C-reactive protein, Fcal—fecal calprotectin, HBI—Harvey Bradshaw Index.

Figure 3

Clinical remission rate at week 12 across patient and disease characteristic subgroups (n = 48). * p < 0.05. Abbreviations: EIM—extra-intestinal manifestations, CDED—Crohn’s disease exclusion diet, PEN—Partial enteral nutrition.

Figure 4

Clinical improvement at week 12 by adherence to the CDED among patients with active disease at diet initiation (n = 72). High adherence to the CDED was defined as very/fairly adherent. ΔHBI score is the difference between HBI scores at baseline and week 12 (baseline-week 12). Abbreviations: HBI—Harvey Bradshaw Index.