title: Partial enteral nutrition with a Crohn's disease exclusion diet is effective for induction of remission in children and young adults with Crohn's disease.
abstract: BACKGROUND
  Exclusive enteral nutrition is effective for inducing remission in active pediatric Crohn's disease. Partial enteral nutrition (PEN) with free diet is ineffective for inducing remission, suggesting that the mechanism depends on exclusion of free diet. We developed an alternative diet based on PEN with exclusion of dietary components hypothesized to affect the microbiome or intestinal permeability.
  
  
  METHODS
  Children and young adults with active disease defined as a pediatric Crohn's disease activity index >7.5 or Harvey-Bradshaw index ≥4 received a 6-week structured Crohn's disease exclusion diet that allowed access to specific foods and restricted exposure to all other foods, and up to 50% of dietary calories from a polymeric formula. Remission, C-reactive protien, and erythrocyte sedimentation rate were reevaluated at 6 weeks. The primary endpoint was remission at 6 weeks defined as Harvey-Bradshaw index ≤3 for all patients and pediatric Crohn's disease activity index <7.5 in children.
  
  
  RESULTS
  We treated 47 patients (mean age, 16.1 ± 5.6 yr; 34 children). Response and remission were obtained in 37 (78.7%) and 33 (70.2%) patients, respectively. Mean pediatric Crohn's disease activity index decreased from 27.7 ± 9.4 to 5.4 ± 8 (P < 0.001), Harvey-Bradshaw index from 6.4 ± 2.7 to 1.8 ± 2.9 (P < 0.001). Remission was obtained in 70% of children and 69% of adults. Normalization of previously elevated CRP occurred in 21 of 30 (70%) patients in remission. Seven patients used the diet without PEN; 6 of 7 obtained remission.
  
  
  CONCLUSIONS
  Dietary therapy involving PEN with an exclusion diet seems to lead to high remission rates in early mild-to-moderate luminal Crohn's disease in children and young adults.
authors.affiliation: *Pediatric Gastroenterology Unit, Wolfson Medical Center, †Epidemiology Unit, Wolfson Medical Center, and ‡Sackler School of Medicine, Tel Aviv University, Holon, Israel.
authors.forename: Rotem
authors.initials: R
authors.lastname: Sigall-Boneh
authors.forename: Tamar
authors.initials: T
authors.lastname: Pfeffer-Gik
authors.forename: Idit
authors.initials: I
authors.lastname: Segal
authors.forename: Tsili
authors.initials: T
authors.lastname: Zangen
authors.forename: Mona
authors.initials: M
authors.lastname: Boaz
authors.forename: Arie
authors.initials: A
authors.lastname: Levine
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003424:Crohn Disease / Q000628:therapy*; D004032:Diet; D002149:Energy Intake; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005526:Food, Formulated; D006801:Humans; D008297:Male; D011379:Prognosis; D012074:Remission Induction; D055815:Young Adult