Ingested matter affects intestinal lesions in Crohn's disease.
BACKGROUND
Environmental factors of the modern Western lifestyle may trigger Crohn's disease (CD) in susceptible individuals. Because such factors could be part of ingested matter, we intended to improve intestinal Crohn's lesions by exclusion thereof.


METHODS
At first we tested a highly restricted diet (based on spelt bread and red meat, both derived from intensively monitored organic farming) in 5 pilot cases. In a subsequent controlled trial, 18 patients with mild-to-moderate CD were randomly assigned to receive either this active diet or a control diet (low-fiber, low-fat, and high-carbohydrate). Mucosal improvement was assessed by magnetic resonance imaging (MRI) and endoscopy. Secondary endpoints included sonography, the Crohn's Disease Activity Index (CDAI), and the Inflammatory Bowel Disease Questionnaire (IBDQ).


RESULTS
Four of 5 pilot patients showed significant improvement within 4 weeks. From 18 patients in the controlled trial, 8 were randomized to the active and 10 to the control group; 4 decided to quit immediately after dietary counseling, 3 in the active and 1 in the control group (P = 0.183). At 6 weeks MRI and endoscopy showed improvement of intestinal lesions in 3 of 4 assessable patients of the active group and 1 of 9 patients of the control group (P = 0.027). Sonography showed improvement in 4 of 5 patients of the active group and in 1 of 8 assessable patients of the control group (P = 0.016). CDAI and IBDQ improved in both groups to a similar extent.


CONCLUSIONS
Ingested matter as part of the modern Western lifestyle may cause persistence of intestinal Crohn's lesions.
Bartel
Gregor
G
Department of Medicine 3, Division of Gastroenterology and Hepatology, Medical University of Vienna, Währinger Gürtel 18, Vienna, Austria.
Weiss
Ilse
I
Turetschek
Karl
K
Schima
Wolfgang
W
Püspök
Andreas
A
Waldhoer
Thomas
T
Gasche
Christoph
C
D000328:Adult; D003424:Crohn Disease / Q000175:diagnosis* / Q000178:diet therapy*; D004038:Diet, Reducing / Q000379:methods*; D018450:Disease Progression; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008019:Life Style; D008279:Magnetic Resonance Imaging; D008297:Male; D010865:Pilot Projects; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires