Foods Not To Eat With Crohn's Disease

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Foods Not To Eat With Crohn's Disease

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Treating Inflammatory Bowel Disease With Diet: A Taste Test

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Inflammatory Bowel Disease And Psoriasis: Modernizing The Multidisciplinary Approach

By Charlotte M. Verburgt 1, 2, †, Mohammed Ghiboub 1, 2, †, Marc A. Benninga 1, Wouter J. de Jonge 2, 3 and Johan E. Van Limbergen 1, 2, 4, *

Department of Gastroenterology and Child Nutrition, Emma Children’s Hospital, University of Amsterdam Medical Center, 1105 AZ Amsterdam, The Netherlands

Tytgat Institute for Liver and Intestine Research, Metabolism Endocrinology Gastroenterology Amsterdam, University of Amsterdam Medical Center, University of Amsterdam, 1105 BK Amsterdam, Netherlands

Accepted: 10 December 2020 / Revised: 7 January 2021 / Accepted: 9 January 2021 / Published: 13 January 2021

What Is Crohn’s Disease? + Diagnosis, Treatment & Diet

The increasing incidence of pediatric Crohn’s disease (CD) worldwide is strongly associated with a shift in diet towards a Western diet, which in turn leads to changes in the gut microbiota and disturbances in immunity and intestinal metabolism. Several clinical studies in children with CD have demonstrated high efficacy of nutritional therapy with exclusive enteral nutrition (EEN) in inducing remission with an excellent safety profile. However, EEN is poorly tolerated, which limits its compliance and clinical applicability. This has increased interest in the development of alternative and better tolerated nutritional therapy strategies. Several nutritional therapies are now designed not only to treat the nutritional deficiencies seen in children with active CD, but also to correct dysbiosis and reduce intestinal inflammation. In this review, we report recent findings on nutritional strategies in children with active CD: EEN, partial enteral nutrition (PEN), Crohn’s disease exclusion diet (CDED) and diet for the treatment of CD with nutrition (CD-TREAT). We describe their regulatory, effectiveness, safety and (dis)advantages as well as some mechanisms of action and their potential perspectives. Better understanding of the different nutritional therapy options and their mechanisms will lead to better and safer management strategies for children with CD and can overcome the constraints and limitations of current strategies in children.

Crohn’s disease (CD) is a chronic disorder that belongs to the group of inflammatory bowel diseases (IBD); it is characterized by transmural inflammation that can affect any area along the proximal-distal axis of the gastrointestinal (GI) tract [1, 2, 3]. Symptoms often include abdominal pain, diarrhea, loss of rectal blood, and fatigue, and the disease often results in weight loss and malnutrition [4]. The incidence of CD is increasing worldwide, and the onset of the disease can occur at any age [5]. Up to 15% of patients with CD are diagnosed before the age of 20 [6, 7, 8]. The incidence of pediatric CD is steadily increasing and varies from 2.5 to 11.4 per 100,000, although a recent meta-analysis has concluded that the incidence in Europe is between 9-10 per 100,000. Several studies have reported the prevalence of pediatric IBD, but overall, there is an estimated prevalence of 58/100,000, although the contribution of pediatric cases to the overall burden of IBD society remains low due to the increasing prevalence of adult-onset disease [5, 9, 10]. . While the etiology of CD may be similar in children and adults, children with CD usually have a more broad/panenteric phenotype; however, the time to develop into stricture and penetrating complications is similar [11, 12]. Because their disease course occurs during a period of growth and development, children are particularly vulnerable, and management strategies must take into account growth characteristics [13, 14]. CD is considered a multifactorial disorder, in which genetics, environment, gut microbiota, and immune system interact to contribute to disease development [3, 15, 16]. However, despite extensive research on CD, treatment remains focused on immunosuppressive actions and the etiology is not fully understood.

CD is characterized by excessive leukocyte infiltration into the inflamed mucosa and high levels of secreted proinflammatory cytokines [17, 18]. Therefore, drug regimens are focused on using immunomodulators or β-suppressants (such as corticosteroids, methotrexate, thiopurine, and biologics such as antitumor necrosis factor alpha (TNFα)) to reduce immune system activity [9, 19]. However, some side effects, such as an increased risk of infection and malignancy, are associated with the use of immunomodulators and β-suppressants [9]. In turn, corticosteroid use in pediatric CD is associated with growth retardation and reduced bone growth [9, 20, 21, 22].

Extensive studies have been performed to correlate microbiome changes with active disease and/or response to treatment [23, 24, 25, 26, 27, 28, 29]. Indeed, microbiome manipulation with antibiotics showed promise as a therapeutic strategy for the treatment of pediatric CD in randomized controlled trials (RCTs) of azithromycin + metronidazole for luminal CD [9, 19, 30, 31]. Antibiotics are also indicated to help maintain anti-TNF remission in perianal CD [9, 32, 33]. Although various immunosuppressants and antibiotics may provide therapeutic benefit in CD, a minority of patients maintain remission after induction of remission without maintenance therapy. In addition, there is a significant rate of primary non-response and loss of response to immunosuppressants, leading to a high and unmet need for new effective therapies [34, 35, 36, 37].

Things Only People With Crohn’s Disease Know

A major factor in the composition and ecology of the gut microbiota is nutrition. Diet has been found to profoundly influence the gut microbiota, which has been identified as a key player in the regulation of metabolism and immune response [38, 39, 40]. Several studies have highlighted the impact of changes in dietary intake and the consequent industrialization of foods (such as the Western diet, which is high in fat and carbohydrates) on the gut microbiome (dysbiosis) and the increased incidence of CD in children. [3, 5, 26, 41 , 42, 43]. This provides a strong rationale for further investigation of nutrition as a potential therapy for inducing or maintaining remission in pediatric CD. While current medical therapy is primarily aimed at fighting inflammation, nutritional therapy may be aimed at improving dysbiosis and metabolism, and reducing inflammation [9]. Recent European guidelines have confirmed the central role of dietary therapy (especially exclusive enteral nutrition (EEN)) in the treatment of mild to moderate CD, emphasizing the need for rigorous clinical studies of new nutritional strategies (including better tolerated Crohn’s disease). disease exclusion diet (CDED)) [9]. In recent years, a number of nutritional therapy strategies have been devised to reduce food exposure to foods that can adversely impact the microbiome, gut barrier, and innate immunity [3, 9, 44]. In this review, we summarize recent developments regarding various nutritional therapies to induce and maintain remission in pediatric CD. We discuss therapeutic protocols, efficacy, safety, (dis)benefits, and their potential mechanisms.

To provide an overview of nutritional therapy available in pediatric CDs and gather the most relevant achievements in research in the field of nutritional therapy, we conducted a review of the literature at Medline (PubMed) using “Crohn’s disease”, “nutritional therapy”, “(partial) enteral nutrition”. . , “diet”, “mechanism” and “pediatrics” as keywords. Reference lists of existing (systematic) reviews on this topic were searched for additional relevant literature. All articles included are in English. There were no specific inclusion or exclusion criteria for this narrative review. To describe the different types of nutritional therapy and their effectiveness, we focus on studies conducted in children. The most contributing articles were selected and described in Section 4, with an overview of the characteristics and results of the study shown in Table 1.

The constant increase in the incidence of IBD goes hand in hand with the different western positions of the continents [24, 26]. In particular, mostly Western diets

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