Sigall Boneh Rotem, Van Limbergen Johan, Wine Eytan, Assa Amit, Shaoul Ron, Milman Peri, Cohen Shlomi, Kori Michal, Peleg Sarit, On Avi, Shamaly Hussein, Abramas Lee, Levine Arie
Wolfson Medical Center, Pediatric Gastroenterology, Holon, Israel; The Sackler Faculty of medicine, Tel Aviv University, Tel Aviv, Israel.
Emma Children's Hospital, Amsterdam University Medical Centers - location AMC, Amsterdam, the Netherlands.
Clin Gastroenterol Hepatol. 2021 Apr;19(4):752-759. doi: 10.1016/j.cgh.2020.04.006. Epub 2020 Apr 14.
BACKGROUND & AIMS: Dietary therapies based on exclusion of usual dietary elements induce remission in children with Crohn's disease (CD), whereas re-exposure induces rebound inflammation. We investigated whether a short trial of dietary therapy, to identify patients with and without a rapid response or remission on the diet (DiRe), can be used to predict success or failure of long-term dietary therapy.
We collected data from the multicenter randomized trial of the CD exclusion diet (CDED). We analyzed data from 73 children with mild to moderate CD (mean age, 14.2 ± 2.7 y) randomly assigned to groups given either exclusive enteral nutrition (EEN, n = 34) or the CDED with 50% (partial) enteral nutrition (n = 39). Patients were examined at baseline and at weeks 3 and 6 of the diet. Remission was defined as CD activity index scores below 10 and response was defined as a decrease in score of 12.5 points or clinical remission. Inflammation was assessed by measurement of C-reactive protein.
At week 3 of the diet, 82% of patients in the CDED group and 85% of patients in the EEN group had a DiRe. Median serum levels of C-reactive protein had decreased from 24 mg/L at baseline to 5.0 mg/L at week 3 (P < .001). Among the 49 patients in remission at week 6, 46 patients (94%) had a DiRe and 81% were in clinical remission by week 3. In multivariable analysis, remission at week 3 increased odds of remission by week 6 (odds ratio, 6.37; 95% CI, 1.6-25; P = .008) whereas poor compliance reduced odds of remission at week 6 (odds ratio, 0.75; 95% CI, 0.012-0.46; P = .006).
For pediatric patients with active CD, dietary therapies (CDED and EEN) induce a rapid clinical response (by week 3). Identification of patients with and without a rapid response to diet might help identify those who, with compliance, will be in clinical remission by week 6 of the diet. ClinicalTrials.gov no: NCT01728870.
基于排除常见饮食成分的饮食疗法可使克罗恩病（CD）患儿病情缓解，而重新接触这些成分会引发炎症反弹。我们研究了短期饮食疗法试验，以确定对饮食有或无快速反应或缓解的患者（饮食反应，DiRe），是否可用于预测长期饮食疗法的成败。
我们收集了CD排除饮食（CDED）多中心随机试验的数据。我们分析了73例轻度至中度CD患儿（平均年龄14.2±2.7岁）的数据，这些患儿被随机分为两组，分别给予全肠内营养（EEN，n = 34）或含50%（部分）肠内营养的CDED（n = 39）。在基线以及饮食第3周和第6周对患者进行检查。缓解定义为CD活动指数评分低于10分，反应定义为评分降低12.5分或临床缓解。通过测量C反应蛋白评估炎症情况。
在饮食第3周时，CDED组82%的患者和EEN组85%的患者有饮食反应。C反应蛋白的血清中位数水平从基线时的24 mg/L降至第3周时的5.0 mg/L（P < .001）。在第6周缓解的49例患者中，46例（94%）有饮食反应，到第3周时81%处于临床缓解状态。在多变量分析中，第3周缓解增加了第6周缓解的几率（比值比，6.37；95%置信区间，1.6 - 25；P = .008），而依从性差则降低了第6周缓解的几率（比值比，0.75；95%置信区间，0.012 - 0.46；P = .006）。
对于患有活动性CD的儿科患者，饮食疗法（CDED和EEN）可诱导快速临床反应（到第3周）。识别对饮食有或无快速反应的患者可能有助于确定那些依从性好且在饮食第6周时将实现临床缓解的患者。ClinicalTrials.gov编号：NCT01728870。
