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Can nutritional therapy replace pharmacologic therapy in pediatric Crohn's disease?

Nature Clinical Practice Gastroenterology & Hepatology volume 6, pages 80–81 (2009)Cite this article

Nutritional therapy with an amino-acid-based, enteral-formula diet was introduced to the therapeutic armamentarium for Crohn's disease by O'Morain and colleagues in 1985.1 This study compared the therapeutic efficacy of enteral nutrition with that of glucocorticoids for the induction of clinical remission in a group of steroid-dependent adult patients with Crohn's disease. The rationale for using enteral nutrition in these patients was that it would decrease the load of dietary antigens in the intestinal lumen, and thus downregulate the inflammatory response. Both enteral nutrition and glucocorticoids had similar therapeutic efficacy for inducing clinical remission in this study.1 Enteral-nutrition therapy for Crohn's disease was subsequently examined by several investigators who assessed polymeric formula diets, and these studies yielded variable results.2,3 However, meta-analyses that compared the therapeutic efficacy of enteral nutrition with that of glucocorticoids in adult patients with mild to moderately severe Crohn's disease have shown a 60% clinical-remission rate for patients treated with enteral nutrition and 80% for patients treated with corticosteroids.2,3 This 60% clinical-remission rate associated with enteral nutrition is similar to that observed in clinical trials of budesonide or prednisone.4,5

The therapeutic mechanism of enteral nutrition in Crohn's disease is far from clear. The major mechanism of action of an amino-acid-based diet is unlikely to be a decrease in intestinal antigenic load, as similar rates of clinical remission have been obtained with relatively more antigenic, whole-protein diets.2 Changes in gut microbiota induced by enteral nutrition have been postulated as a potential therapeutic mechanism; however, these changes have not been shown in adults when enteral diets that lack dietary fiber or oligosaccharides have been used.6 Fat content in the enteral diet (either quantitative or qualitative) might also be important, as formulas with the same amount of fat, but different fat compositions, have been associated with totally different clinical-remission rates when used as primary therapies in adult patients with Crohn's disease.7

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  1. Hospital Universitari, Germans Trias Pujol, Health Science Research Institute, Germans Trias I Pujol Foundation, Barcelona, Spain mgassull.germanstrias@gencat.net

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  1. MA Gassull is Emeritus Consultant of Gastroenterology and Director of the Health Science Research Institute at the Germans Trias I Pujol Foundation, Barcelona, Spain.,

    Miquel A Gassull

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Gassull, M. Can nutritional therapy replace pharmacologic therapy in pediatric Crohn's disease?. Nat Rev Gastroenterol Hepatol 6, 80–81 (2009). https://doi.org/10.1038/ncpgasthep1338

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