Pediatric Gastroenterology and Nutrition Unit, PIBD Research Unit, Wolfson Medical Center, Holon, Israel.
IBD Center, Department of Gastroenterology and Liver Diseases, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel.
J Crohns Colitis. 2017 Oct 1;11(10):1205-1212. doi: 10.1093/ecco-jcc/jjx071.
Loss of response [LoR] to biologics in Crohn's disease [CD] is a significant clinical problem. Dietary therapy as a treatment strategy in this setting has not been previously reported. We report the use of dietary strategies using enteral nutrition coupled with the Crohn's Disease Exclusion Diet [CDED] for LoR to infliximab or adalimumab as a single-centre experience.
Patients with LoR to a biologic despite dose escalation or combination therapy were treated with partial enteral nutrition [PEN] by a polymeric formula and the CDED for 12 weeks. Paediatric patients with severe flares received 14 days of exclusive enteral nutrition followed by PEN + CDED as above. All patients were seen at weeks 6 and 12 for follow up. Current and prior treatment, Harvey Bradshaw Index [HBI], C-reactive protein [CRP] and albumin were recorded. Remission was defined as HBI <5 at week 6.
Twenty-one patients, mean age 22.1 ± 8.9 years [11 adults and ten children] met study criteria. Seventeen patients [81%] had used combination therapy, and 10/21 [47.6%] had failed a second biologic. Seven patients had a prior intestinal resection. Dose escalation had failed in 13/21 [62%] patients. Clinical remission by physician's global assessment and HBI after 6 weeks was obtained in 13/21 [61.9%]. Mean HBI decreased from 9.4 ± 4.2 to 2.6 ± 3.8 [p < 0.001], mean CRP decreased from 2.8 ± 3.4 to 0.7 ± 0.5 [p = 0.005] and mean albumin increased from 3.5 ± 0.6 to 3.8 ± 0.5 [p = 0.06].
Dietary treatment combining PEN with the CDED may be a useful salvage regimen for patients failing biological therapy despite dose escalation.
克罗恩病（CD）患者对生物制剂失去应答是一个严重的临床问题。在这种情况下，饮食治疗作为一种治疗策略尚未见报道。我们报告了一种使用肠内营养联合克罗恩病排除饮食（CDED）的饮食策略，用于对英夫利昔单抗或阿达木单抗失去应答的单中心经验。
对生物制剂应答丧失的患者，尽管进行了剂量升级或联合治疗，仍采用聚合配方的部分肠内营养（PEN）和 CDED 治疗 12 周。严重发作的儿科患者接受 14 天的完全肠内营养，然后如上所述使用 PEN+CDED。所有患者在第 6 和 12 周进行随访。记录当前和既往治疗、Harvey Bradshaw 指数（HBI）、C 反应蛋白（CRP）和白蛋白。缓解定义为第 6 周时 HBI<5。
21 例患者符合研究标准，平均年龄 22.1±8.9 岁（11 例成人和 10 例儿童）。17 例（81%）患者接受了联合治疗，10/21（47.6%）例患者生物制剂治疗失败。7 例患者有肠切除术史。21 例患者中，13 例（62%）患者剂量升级失败。21 例患者中有 13 例（61.9%）在第 6 周时通过医生的总体评估和 HBI 获得临床缓解。HBI 从 9.4±4.2 降至 2.6±3.8（p<0.001），CRP 从 2.8±3.4 降至 0.7±0.5（p=0.005），白蛋白从 3.5±0.6 增至 3.8±0.5（p=0.06）。
尽管进行了剂量升级，PEN 联合 CDED 的饮食治疗可能是一种对生物治疗失败的患者有用的挽救方案。
