Enteral nutrition and dietary modification in adult and paediatric Crohn's disease: a systematic review

Abstract

Background: Crohn's disease (CD) is an inflammatory bowel disease (IBD) that causes exacerbations of inflammation in the gastrointestinal tract, with secondary symptoms including malnutrition and weight loss. Its aetiology is related to genetics, the intestinal microbiome and environmental factors, and treatment aims to manage symptoms and induce remission. Aims: This systematic literature review considers the evidence for common dietary modifications and nutritional support for both adult and paediatric CD patients. Methods: PubMed and Google Scholar were searched for randomised control trials or others relating to diet and nutritional interventions in CD patients. Results: Eight articles were selected that met inclusion criteria. There was some limited evidence for the use in adults of low-FODMAP, gluten-free, IgG4-guided exclusion, low-residue, paleo and specific-carbohydrate diets. Only the specific-carbohydrate diet was studied in children. Partial and exclusive enteral nutrition were effective interventions in both populations, though more commonly used in children. Conclusion: In paediatric patients, enteral nutrition is the preferred treatment for severe CD. In adult CD, IgG4-exclusion diets are particularly likely to help induce remission. More research is needed before any conclusive recommendations can be made.