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. 2024 Sep;79(3):592-601.
doi: 10.1002/jpn3.12283. Epub 2024 Jul 4.

A real-life pediatric experience of Crohn's disease exclusion diet at disease onset and in refractory patients

Luca Scarallo  1   2 , Elena Banci  3 , Alessia De Blasi  1 , Monica Paci  1 , Sara Renzo  1 , Sara Naldini  1 , Jacopo Barp  1 , Saverio Pochesci  1 , Lorenzo Fioretti  1 , Benedetta Pasquini  4 , Duccio Cavalieri  5 , Paolo Lionetti  1   2
Affiliations

A real-life pediatric experience of Crohn's disease exclusion diet at disease onset and in refractory patients

Luca Scarallo et al. J Pediatr Gastroenterol Nutr. 2024 Sep.

Abstract

Objectives: We aimed to appraise the real-life efficacy of Crohn's disease exclusion diet (CDED) coupled with partial enteral nutrition (PEN) in inducing clinical and biochemical remission at disease onset and in patients with loss of response to biologics and immunomodulators.

Methods: We retrospectively gathered data of patients aged less than 18 years of age with a diagnosis of Crohn's disease (CD), who received CDED coupled with PEN at a tertiary level pediatric inflammatory bowel disease center.

Results: Sixty-six patients were identified. Forty (60.6%) started CDED plus PEN at disease onset and 26 (39.4%) received CDED with PEN as add-on therapy. Forty-six (69.7%) patients achieved clinical remission (weighted Pediatric Crohn's Disease Activity Index < 12.5) at the end of phase 1, 44 (66.7%) normalized c-reactive protein levels (<0.5 mg/dL) and 18 (27.2%) patients normalized calprotectin levels (<150 µg/g). Nine of 19 (47.3%) of patients with clinically severe disease (defined by Physician Global Assessment) achieved clinical remission at the end of phase I. Patients with extraintestinal manifestations had statistically lower clinical response rates to the dietary regimen (p = 0.018). Among patients who received CDED + PEN as add-on treatment, a previous successful course of Exclusive Enteral Nutrition was associated with statistically higher clinical remission rates at Week 8 (p = 0.026). Clinical response at Week 4 was an independent predictor of clinical remission and fecal calprotectin normalization at Week 8 (p = 0.002).

Conclusion: CDED with PEN confirmed its efficacy in a real-life setting, proving to be effective also in refractory patients and those with severe disease. Early clinical response predicts clinical remission at the end of phase 1.

Keywords: CD; CDED; PEN; nutritional therapies.

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References

REFERENCES

    1. Kuenzig ME, Fung SG, Marderfeld L, et al. Twenty‐first century trends in the global epidemiology of pediatric‐onset inflammatory bowel disease: systematic review. Gastroenterology. 2022;162:1147‐1159.e4.
    1. Alvisi P, Labriola F, Scarallo L, et al. Epidemiological trends of pediatric IBD in Italy: a 10‐year analysis of the Italian society of pediatric gastroenterology, hepatology and nutrition registry. Dig Liver Dis. 2022;54:469‐476.
    1. Fitzpatrick JA, Melton SL, Yao CK, Gibson PR, Halmos EP. Dietary management of adults with IBD—the emerging role of dietary therapy. Nat Rev Gastroenterol Hepatol. 2022;19:652‐669.
    1. Scarallo L, Lionetti P. Dietary management in pediatric patients with Crohn's disease. Nutrients. 2021;13:1611.
    1. van Rheenen PF, Aloi M, Assa A, et al. The medical management of paediatric Crohn's disease: an ECCO‐ESPGHAN guideline update. J Crohns Colitis. 2021;15:171‐194.

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