title: Treatment of Crohn's Disease with an IgG4-Guided Exclusion Diet: A Randomized Controlled Trial.
abstract: OBJECTIVE
  We previously reported an improvement in symptoms in Crohn's disease following an IgG4-guided exclusion diet in an open-label study. We aimed to evaluate, in a double-blinded randomized sham-controlled setting, the efficacy of IgG4-guided diet in improving quality of life in patients with Crohn's disease.
  
  
  METHODS
  Consecutive patients with Crohn's disease and a Crohn's disease activity index (CDAI) of 80-400 attending tertiary and secondary care centers were screened. All patients had IgG4 titers tested against 16 common food types using ELISA. The true diet group excluded four food types with the highest antibody titers for 4 weeks, and the sham group excluded four foods with the lowest antibody titers. Quality of life was assessed using the Short Inflammatory Bowel Disease Questionnaire (SIBDQ) at beginning and end of the trial. Secondary outcome measures were CDAI, Harvey Bradshaw index, serum C-reactive protein, and fecal calprotectin.
  
  
  RESULTS
  One hundred and forty-five subjects were screened and 96 subjects had initial food antibody testing performed with 76 patients completing the study. Milk, beef, pork and egg were the most commonly excluded food types in the true diet group. There was a 3.05 (0.01-6.11) p < 0.05 improvement in SIBDQ and 41 (10.4-71.5) in CDAI p = 0.009.
  
  
  CONCLUSIONS
  IgG4-guided exclusion diet, as an adjunct, can improve quality of life and symptoms in patients with CD.
authors.affiliation: Colorectal Surgery, St George's Hospital, Blackshaw Road, London, SW17 0QT, UK.
authors.forename: Viran
authors.initials: V
authors.lastname: Gunasekeera
authors.affiliation: Gastroenterology, Croydon University Hospital, 530 London Rd, Thornton Heath, Surrey, CR7 7YE, UK.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Mendall
authors.affiliation: Gastroenterology, St George's Hospital, Blackshaw Road, London, SW17 0QT, UK.
authors.forename: Derek
authors.initials: D
authors.lastname: Chan
authors.affiliation: Colorectal Surgery, St George's Hospital, Blackshaw Road, London, SW17 0QT, UK. dkumar@sgul.ac.uk.
authors.forename: Devinder
authors.initials: D
authors.lastname: Kumar
mesh_terms: D000328:Adult; D003424:Crohn Disease / Q000178:diet therapy* / Q000276:immunology; D004032:Diet / Q000706:statistics & numerical data; D005260:Female; D005512:Food Hypersensitivity / Q000276:immunology*; D006801:Humans; D007074:Immunoglobulin G / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D007074:Immunoglobulin G
keywords: Crohn’s disease; Exclusion diet; Food sensitivity; IgG4
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