Children with Crohn’s disease get relief with exclusion diet

Exclusion diet appears to be safe and effective for inducing and maintaining remission in children with mild-to-moderate Crohn’s disease (CD), as shown in a small, single-centre study.

Among the 24 patients who adopted the CD exclusion diet, the paediatric CD Activity Index (PCDAI) scores dropped significantly from baseline to weeks 6, 12, and 24 (p=0.02), reported lead author Prof Joseph Runde from Ann & Robert H Lurie Children’s Hospital of Chicago in Chicago, Illinois, US. [CCC 2025, Runde J, et al]

Corticosteroid-free clinical remission was achieved in 78 percent (14/18), 92 percent (11/12), and 80 percent (8/10) of children who remained adherent to the diet at weeks 6, 12, and 24, respectively, Runde added.

Along with remission, the diet also led to improvements in faecal calprotectin concentration and clinical symptoms. Runde noted that calprotectin levels significantly decreased from 3,982 μg/g at baseline to 504 μg/g at week 24 (p<0.01), whereas albumin, haemoglobin, erythrocyte sedimentation rate, and C-reactive protein levels remained unchanged.

Furthermore, four of the six patients (67 percent) who underwent endoscopic assessment showed response (at least a 2-point decrease in Simple Endoscopic Score (SES)-CD), and two (33 percent) achieved remission.

Side effects were mild and included increased abdominal pain in four patients (17 percent), diarrhoea in three (13 percent), and weight loss in two (8 percent). The weight loss ranged from 5 percent to 10 percent of the patients’ total body weight, but this was temporary, stabilizing by week 6, as Runde pointed out.

The CD exclusion diet emphasizes consumption of foods beneficial to the gut microbiome while reducing exposure to food that can exacerbate disease activity. The diet progresses through three 6-week phases, with calorie intake from enteral formula gradually reduced: 50% formula with mandatory foods at phase 1, 25% formula with mandatory foods at phase 2, and then 25% formula without mandatory foods at phase 3. Patients and their caregivers may opt to continue the diet for maintenance after completing the three phases.

With the diet, patients are limited to one yogurt per day, two slices of bread per day, and one portion of seafood and lean steak per week. Processed meat, seeds, and foods with artificial sweeteners/processed foods/preservatives/artificial additives and emulsifiers are excluded.

Recognizing the challenges children face in adhering to dietary changes, Runde stressed that dietitian support is crucial for the successful uptake of dietary therapy. “More must be done to help families bridge the gap between recommendation and implementation.”

For the study, Runde and colleagues looked at a cohort of 419 paediatric patients with CD, of whom 32 met with a CD-focused dietitian regarding the exclusion diet. Only 24 individuals adopted it. The mean age at diagnosis was 11 years, and most patients were male (75 percent) and White (83 percent). Nearly all patients (96 percent) had nonstricturing, nonpenetrating CD, and 88 percent had no history of CD-related surgery.

The median time to diet initiation was 2.4 months from diagnosis, and the duration of follow-up was a median of 23.6 months.