Treatment of Crohn’s disease with complex fistula disease using an exclusion diet

Abstract

Exclusive Enteral Nutrition (EEN) is considered the standard of care for the treatment of children with Crohns Disease (CD) but it is rarely used in adults. The main reason for this might be severe dietary restrictions, resulting in a reduced quality of life and a lack of compliance with the diet. The development of less restrictive dietary strategies has improved therapy adherence and thus also the success of the therapy in recent years. The therapy of fistulas in CD is generally considered difficult and nutritional therapy for fistulas has not been systematically investigated. We present the case of a patient with fistulizing CD. Immunosuppressive therapy with a biological was complicated by urothelial carcinoma, and an alternative treatment had to be found. In our patient, Crohns Disease Exclusion Diet (CDED) and Partial Enteral Nutrition (PEN) resulted in normal stool consistency and frequency, and one and a half years after the start of the exclusion diet, the patient remains in clinical remission.