Diet therapy appears to induce remission in some with biologics-resistant Crohn�??s

Reuters Health Information: Diet therapy appears to induce remission in some with biologics-resistant Crohnâ??s

Diet therapy appears to induce remission in some with biologics-resistant Crohnâ??s

Last Updated: 2017-06-08

By Anne Harding

NEW YORK (Reuters Health) - Some Crohn’s disease (CD) patients who are not helped by biologics go into remission when treated with diet alone, new research shows.

“Dietary therapies may be a very potent tool that may have effects in certain individuals (and) that are as important as medical therapies or drugs,” Dr. Arie Levine of Wolfson Medical Center in Holon, Israel, who worked on the study, told Reuters Health by phone.

Exclusive enteral nutrition (EEN) can induce remission and promote mucosal healing in CD, and is currently recommended as a first-line treatment for children with mild to moderate disease, Dr. Levine and his team write in their report, online May 19 in the Journal of Crohn’s and Colitis. However, EEN requires six to 12 weeks of treatment, which can be difficult for adults.

The researchers have hypothesized that excluding foods that promote dysbiosis, alter innate immunity or change intestinal permeability can help treat inflammatory bowel disease (IBD), and that in fact avoiding some foods and promoting consumption of others can help patients who are not good candidates for EEN. They have developed the Crohn’s Disease Exclusion Diet (CDED) based on this idea. Dr. Levine and his team now use CDED, along with partial enteral nutrition (PEN), as standard outpatient therapy.

In a study published in 2014, the researchers found that CDED with PEN induced remission in children and young adults. In the new study, they tested PEN and CDED in 21 patients, including 11 adults, to investigate the role of diet in patients with established disease.

Seventeen patients had been treated with combination therapy, 10 had failed treatment with a second biologic and seven had a previous intestinal surgery. Dose escalation had failed to work for 13 patients.

Patients were treated with PEN and CDED for 12 weeks. After six weeks, 13 patients achieved remission, based on physician’s global assessment and Harvey Bradshaw Index (HBI). Mean HBI dropped from 9.4 to 2.6 (p<0.001), mean C-reactive protein went from 2.8 to 0.7 (p=0.005), and mean albumin from 3.5 to 3.8 (p=0.06).

“A very large proportion of these patients, 61% in this paper, went into remission with dietary therapy,” Dr. Levine said. “Half of them were adults and many of them had long-standing disease. Dietary therapy should probably play a more important role in the treatment of Crohn’s disease.”

The CDED is not in the public domain, the researcher noted, because three randomized trials of the approach are now underway. Dr. Levine said he and his colleagues want to finish the trials and better understand the effects of the diet before publishing it.

“This has a tremendous amount of potential down the line and we just have to refine the tool and learn in which patients we should use it,” he said.

“This paper provides more evidence that partial enteral therapy plus an exclusion diet may be an effective therapy for certain patients with Crohn’s disease,” Dr. Lindsey Albenberg, a pediatric gastroenterologist at the Children’s Hospital of Philadelphia, told Reuters Health. Dr. Albenberg studies diet and IBD, but did not participate in the study.

“It also provides additional evidence that exclusion of potentially harmful components of one’s usual diet may help to improve symptoms and reduce inflammation in patients with CD,” she added. “However, we need larger dietary trials and controlled trials to really understand whether this therapy is effective and to better understand which patients are appropriate to treat with exclusion diets.”

SOURCE: http://bit.ly/2sGU5U8

J Crohns Colitis 2017.

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