Dietary Treatment for Crohn’s Disease—Old Therapy, New Insights

Abstract

Crohn’s disease in childhood accounts for about 25% of the overall prevalence of this condition, and compared with adult-onset disease has unique characteristics in being more likely to involve the colon, being more aggressive in behavior, and requiring early escalation of therapy. Exclusive enteral nutrition has proven to be an effective therapy, especially in children. There are various hypotheses regarding mode of action; however, the precise mechanisms are yet to be established. The aim of this paper is to provide an up-to-date review of the efficacy and mechanism of action of exclusive enteral nutrition in Crohn’s disease. A PubMed search was performed using the terms ‘mechanism of action’, ‘exclusive enteral nutrition’, ’partial enteral nutrition’, ‘nutritional therapy’, ‘children’, ‘paediatric’, ‘Crohn’s disease’. Relevant articles were selected from this search. In addition, the reference lists of these papers were scrutinized for further relevant publications. There is significant evidence for efficacy of exclusive enteral nutrition and some evidence for a number of mechanisms, including alteration of the gut microbiome, a direct anti-inflammatory effect at the mucosal level, and through alteration in the fat content within the diet. Exclusive enteral nutrition provides benefits beyond disease remission, especially through promoting growth; further studies are required to elucidate exactly how it works and the longer-term outcomes. This is particularly important given the lack of negative effects compared with the significant side-effect profile of biological therapies. Improving resources to minimize the psycho-social impact of exclusive enteral nutrition may open the way for wider use in adult patients through the development of solid diet alternatives to liquid feeds.