Topic Highlight
New perspectives on nutritional therapy in Crohn's disease
Arie Levine
There are multiple clues that diet may be an important trigger for IBD. The best evidence to date is for Crohn’s disease. Two different dietary exclusion diets (EEN and the CDED ) have shown very high remission rates accompanied by reduction in inflammation and mucosal healing, and both alter the existing dysbiosis. The most likely mechanism of action is exclusion of various components of Western diet, though it is hard to pin point one food that may cause Crohn’s disease. It has been shown that EEN did not improve intestinal permeability but did induce a reduction in Proteobacteria with an expansion in Clostridiales and Firmicutes, suggesting that the mechanism involves alteration of the microbiome rather than an effect on the host barrier. Diet can also be used as a salvage therapy for patients unresponsive to medical therapy, as a combination therapy (drug and diet instead of two drugs) and in the preoperative setting or when immune suppression is problematic (during infection or when an abscess is present)