Inflamm Bowel Dis. 2024 Oct 3;30(10):1888-1902. doi: 10.1093/ibd/izad255.

Rotem Sigall Boneh ^1 2, Catherine Westoby ³, Ilan Oseran ⁴, Chen Sarbagili-Shabat ^1 5, Lindsey G Albenberg ⁶, Paolo Lionetti ⁷, Víctor Manuel Navas-López ⁸, Javier Martín-de-Carpi ⁹, Henit Yanai ^10 11, Nitsan Maharshak ¹², Johan Van Limbergen ^13 14, Eytan Wine ¹⁵

Author information

¹Pediatric Gastroenterology and Nutrition Unit, The E. Wolfson Medical Center, Holon, Israel.

²Tytgat Institute for Liver and Intestinal Research, Amsterdam Gastroenterology Endocrinology and Metabolism, University of Amsterdam, Amsterdam, the Netherlands.

³Department of Nutrition and Dietetics, University Hospital Southampton NHS Foundation Trust, Southampton, UK.

⁴Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

⁵The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.

⁶Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, USA.

⁷Department Neurofarba, University of Florence, Meyer children's Hospital IRCCS, Florence, Italy.

⁸Pediatric Gastroenterology and Nutrition Unit. Hospital Regional Universitario de Málaga. IBIMA. Málaga, Spain.

⁹Paediatric Gastroenterology, Hepatology and Nutrition Department, Hospital Sant Joan de Déu, Barcelona, Spain.

¹⁰IBD center, Division of Gastroenterology, Rabin Medical center, Petach Tikva, Israel.

¹¹affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

¹²Tel Aviv Medical Center, affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

¹³Department of Paediatric Gastroenterology and Nutrition, Amsterdam University Medical Centers, Emma Children's Hospital, Amsterdam, the Netherlands.

¹⁴Amsterdam Public Health research institute, University of Amsterdam, Amsterdam, the Netherlands.

¹⁵Division of Pediatric Gastroenterology, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.

Abstract

Dietary therapy is increasingly recognized for the management of Crohn's disease (CD) over recent years, including the use of exclusive enteral nutrition (EEN) as first-line therapy for pediatric CD according to current guidelines. The Crohn's disease exclusion diet (CDED) is a whole-food diet designed to reduce exposure to dietary components that are potentially pro-inflammatory, mediated by negative effects on the gut microbiota, immune response, and the intestinal barrier. The CDED has emerged as a valid alternative to EEN with cumulative evidence, including randomized controlled trials, supporting use for induction of remission and possibly maintenance in children and adults. We gathered a group of multidisciplinary experts, including pediatric and adult gastroenterologists, inflammatory bowel diseases (IBD) expert dietitians, and a psychologist to discuss the evidence, identify gaps, and provide insights into improving the use of CDED based on a comprehensive review of CDED literature and professional experience. This article reviews the management of CDED in both children and adults, long-term aspects of CDED, indications and contraindications, selecting the best candidates, identifying challenges with CDED, globalization, the role of the multidisciplinary team, especially of dietitian, and future directions. We concluded that CDED is an established dietary therapy that could serve as an alternative to EEN in many pediatric and adult cases, especially with mild to moderate disease. In severe disease, complicated phenotypes, or with extraintestinal involvement, CDED should be considered on a case-by-case basis, according to physician and dietitians' discretion. More studies are warranted to assess the efficacy of CDED in different scenarios.