Issue 13

Clinical Question

Can partial enteral nutrition (EN) with solid food achieve the same results as complete EN in active Crohn’s disease (CD)?

Editor’s Bottom Line

Partial EN accompanied by an exclusion diet of whole foods is well tolerated by children with CD and appears to be effective. Similar studies of dietary therapy in adults are needed.

Reference

Levine A, Wine E, Assa A, et al. Crohn’s Disease Exclusion Diet Plus Partial Enteral Nutrition Induces Sustained Remission in a Randomized Controlled Trial. Gastroenterol. Epub ahead of print June 4, 2019; https://doi.org/10.1053/j.gastro.2019.04.021

Synopsis

These researchers examined the efficacy of the Crohn’s disease exclusion-diet (CDED), which includes partial enteral nutrition (EN) and diet with whole foods that do not adversely affect gut microbiota and intestinal barrier, as an alternative to complete EN for the treatment of children with mild-to-moderate CD.

They randomized 40 such children to receive the CDED with partial EN accounting for half of their calories for six weeks, followed by CDED and EN accounting for 25% of their calories for an additional six weeks. Another group of 38 patients were randomized to receive complete EN for six weeks followed by an unrestricted diet with 25% of their calories from EN for six weeks. Four patients in the complete EN group withdrew within two days, refusing to continue with the intervention. The remaining 74 participants had a mean age of 14.2 years.

Results showed 75% of children in the CDED plus partial EN group were in corticosteroid-free remission at six weeks, compared to 59% of those on complete EN for six weeks (P=0.38). After 12 weeks, 76% of those in the CDED and partial EN group were in corticosteroid-free remission, compared to 45% of those initially given complete EN followed by unrestricted diet and partial EN (P=0.01). Patients in the CDED and partial EN group who maintained corticosteroid-free remission at week 12 were more likely to have sustained reductions in levels of C-reactive protein, fecal calprotectin, and fecal Proteobacteria.

Almost all of those in the CDED and partial EN group reported tolerating the regimen, compared to 74% of those receiving complete EN initially (P=0.002). Dietary compliance was strongly associated with clinical remission at six weeks.

Details

Study Design: Prospective, controlled
Funding: Nestlé Health Science, the Azrieli Foundation, Women’s and Children’s Health Research Institute and the Canadian Institutes of Health Research.
Allocation: Randomized, double-blind
Setting: Multicenter
Level of Evidence: 1b (Oxford Levels of Evidence)

The summary and conclusion in this issue of E-mentoring in IBD pertains to the manuscript(s) being reviewed, and should be considered in the context of what is already known surrounding the topic and incorporated into practice as deemed appropriate by the individual learner.