Review article: the dietary management of Crohn's disease

Abstract

Enteral feeding has been shown to be as effective as primary therapy for Crohn's disease, but it requires high patient motivation, may be unpalatable and is expensive. However, in adolescents with growth failure and when corticosteroid therapy is contra‐indicated or has failed, it may become the treatment of choice. Furthermore, dietary therapy allows circumvention of the adverse side‐effects of repeated courses of steroids.A number of different hypotheses have been proposed to explain the effect of enteral feeds but none has reached universal acceptance. Prospective trials suggest that the exclusion of whole protein is not necessary. Comparison of feeds with differing composition suggests that a low fat content increases efficacy and various explanations have been offered. The reduction of colonic bacterial load may also be important.Because symptoms of Crohn's disease may be provoked by eating, there is a risk of falsely attributing symptoms to specific foodstuffs. However, in many individuals foods can be identified which affect disease activity, and their exclusion leads to prolongation of disease remission. Dietetic supervision during food testing is important to avoid detrimental effects on nutrient and micronutrient intake.

Dietary Beliefs and Behavior Among Inflammatory Bowel Disease Patients

“…34 Many individuals identified some foods as possibly disease activity and believed that their exclusion could lead to prolongation of disease remission. 35 Dietetic supervision during food testing is important to avoid the detrimental effects on nutrient and micronutrient intake. 35 In our study, less than half of patients reported having received dietetic counselling provide from their gastroenterologist or dietetician.…”

“…35 Dietetic supervision during food testing is important to avoid the detrimental effects on nutrient and micronutrient intake. 35 In our study, less than half of patients reported having received dietetic counselling provide from their gastroenterologist or dietetician. The other sources included general practitioners, family, internet, friends and other IBD patients.…”

Inflammatory bowel diseases: principles of nutritional therapy

“…However, there aren't enough data to support the substitution of drug therapy by EN 50 . Beside other mechanisms, EN decreases CD activity by decreasing the synthesis of inflammatory mediators and by providing specific nutrients 16,32 .…”

“…Recently, excellent literature reviews 50,66,81 and meta-analyses 22,34 concerning primary NT of IBD have been published.…”

“…This fact suggests that some patients may benefit from NT after drug treatment failure 15 In a prospective study comparing TPN, oral diets plus TPN and elemental diets, Greenberg et al 31 observed no significant differences on remission, concluding that the benefits of these regimens were due to nutritional improvement. Recent literature reviews 22,50 and meta-analyses of controlled randomized trials 34 have not shown any significant difference between elemental, oligomeric and polymeric diets concerning initial or late remission of active CD, even though elemental diets are related to earlier remission.…”