title: The effect of elemental diet on intestinal permeability and inflammation in Crohn's disease.
abstract: This study examines whether treatment of acute Crohn's disease with an elemental diet improves intestinal integrity and inflammation as assessed by a 51Cr-labeled ethylenediaminetetraacetatic acid (EDTA) permeability test and the fecal excretion of 111In-labeled autologous leukocytes, respectively. Thirty-four patients with active Crohn's disease completed a 4-week treatment course with an elemental diet. Active disease was characterized by increased intestinal permeability [24-hour urine excretion of orally administered 51Cr-EDTA, 6.4% +/- 0.6% (mean +/- SE); normal, less than 3.0%] and by high fecal excretion of 111In-labeled leukocytes (14.2% +/- 1.1%; normal, less than 1.0%). Twenty-seven (80%) went into clinical remission, usually within a week of starting treatment. After 4 weeks of treatment, there was a significant decrease in both the urine excretion of 51Cr-EDTA (to 3.4% +/- 0.5%; P less than 0.01) and the fecal excretion of 111In (to 5.7% +/- 1.0%; P less than 0.001), indicating that such treatment is not just symptomatic. A framework for the mechanism by which elemental diet works, centering around the importance of the integrity of the intestinal barrier function, is proposed, and also appears to provide a logical explanation for some relapses of the disease.
authors.affiliation: Section of Gastroenterology, Medical Research Council Clinical Research Centre, Harrow, Middlesex, England.
authors.forename: K
authors.initials: K
authors.lastname: Teahon
authors.forename: P
authors.initials: P
authors.lastname: Smethurst
authors.forename: M
authors.initials: M
authors.lastname: Pearson
authors.forename: A J
authors.initials: AJ
authors.lastname: Levi
authors.forename: I
authors.initials: I
authors.lastname: Bjarnason
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D002463:Cell Membrane Permeability; D002860:Chromium Radioisotopes; D003424:Crohn Disease / Q000178:diet therapy* / Q000378:metabolism* / Q000473:pathology; D004492:Edetic Acid; D005260:Female; D005526:Food, Formulated; D006801:Humans; D007205:Indium Radioisotopes; D007413:Intestinal Mucosa / Q000378:metabolism*; D007962:Leukocytes / Q000378:metabolism; D008297:Male; D008875:Middle Aged
chemical_list: D002860:Chromium Radioisotopes; D007205:Indium Radioisotopes; D004492:Edetic Acid