P451. Induction of remission in Crohn's disease in children and young adults using a Crohn's Disease Exclusion Diet (CDED)
A. Levine, R. Sigal, T. Pfeffer Gik, Wolfson Medical Center, Pediatric Gastroenterology Unit, Holon, Israel
Exclusive enteral nutrition is an effective method for inducing remission in active pediatric Crohn's disease. Success appears to depend primarily on exclusion of free diet. Multiple dietary components may alter the microbiome, induce intestinal permeability affect the mucous layer or allow translocation of bacteria in animal models or cell lines. We hypothesized that the effect of EEN is due to exclusion of dietary components that may alter the microbiome or generate an acquired bacterial clearance defect. We developed a diet based on exclusion of these dietary components (Crohn's Disease Exclusion Diet).
Children and young adults with luminal active disease defined as a pediatric Crohn's disease activity index (PCDAI) >7.5 and <40 in children, or Harvey–Bradshaw index (HBI) >3 received a 12 week structured diet that allowed free access to specific unprocessed fresh foods and restricted exposure all other foods. Patients received 50% of calories from a polymeric formula. PCDAI, HBI, CRP and ESR were reevaluated at 6 weeks. The primary endpoint was clinical remission at 6 weeks defined as PCDAI <7.5 in children or HBI <3.
We treated 40 patients (33 <18 yrs, mean age at treatment 16±5.6, range 7.5–32 yrs); the mean disease duration was 2 years. Mean PCDAI decreased from 24.2±8.3 to 6±8.5 (p < 0.001); mean HBI from 5.7±2.8 to 1.5±2.8 (p < 0.001). Remission was obtained in 26/40 patients (65%). Normalization of CRP occurred in 17/26 (65%) patients in remission. Five patients did not use any formula, 4/5 obtained remission just with CDED.
Dietary therapy involving partial enteral nutrition with exclusion of components hypothesized to affect the ability of bacteria to adhere or translocate through the epithelium, appears to lead to high remission rates. This intervention is associated with improvement in inflammation in early mild to moderate luminal Crohn's disease.