Can Partial Enteral Nutrition Induce Crohn’s Disease Remission?

Partial enteral nutrition (PEN) might be helpful for the induction and maintenance of remission in patients with Crohn’s disease (CD), according to a systematic review and meta-analysis of solid food diets for inflammatory bowel disease (IBD) published in Clinical Gastroenterology and Hepatology. 

“After our systematic review on dietary interventions for IBD in 2019, several well-designed randomized controlled trials (RCTs) have been published,” wrote corresponding author Berkeley N. Limketkai, MD, PhD, of the UCLA School of Medicine, Los Angeles, California, and study coauthors. “In this updated systematic review, we … broadened the scope to include PEN – because it includes a solid food component – and prospective observational studies.”

The new meta-analysis included data from a total 27 studies investigating solid food diets in patients with IBD.

For inducing remission in patients with CD, the low refined carbohydrate diet and the symptoms-guided diet performed better than control diets, although there were serious imprecisions in studies, researchers reported. Meanwhile, the Mediterranean diet and the Specific Carbohydrate Diet were similar, and PEN was similar to exclusive enteral nutrition, for inducing CD remission. For maintenance of CD remission, however, only PEN showed potential benefit. Reducing consumption of red meat or refined carbohydrates did not reduce the risk of CD relapse.

For inducing and maintaining remission in patients with ulcerative colitis (UC), no studied diets were found helpful. The reviewers noted a dearth of diets and studies for UC compared with CD, but added that evidence is insufficient to suggest that UC would be any less responsive to dietary intervention than CD.

“Among the most robust dietary trials in IBD currently available, certainty of evidence remains very low or low. Nonetheless, emerging data suggest potential benefit with PEN for induction and maintenance of remission in CD…” researchers wrote. “As more dietary studies become available, the certainty of evidence could improve, thus allowing for more meaningful recommendations for patients.”

Reference
Limketkai BN, Godoy-Brewer G, Parian AM, et al. Dietary interventions for the treatment of inflammatory bowel diseases: an updated systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2023;21(10):2508-2525.e10. doi:10.1016/j.cgh.2022.11.026