Crohnʼs Disease Exclusion Diet (CDED) als Alternative zur exklusiven Ernährungstherapie bei Kindern und Jugendlichen mit Morbus Crohn? Stellungnahme der Arbeitsgemeinschaften CEDATA und Ernährung/Diätetik/Ernährungsmedizin der Gesellschaft für pädiatrische Gastroenterologie und Ernährung e. V.

Zusammenfassung

Epidemiologische und klinische Beobachtungen sowie Tiermodelle weisen auf die Ernährung als Risikofaktor für die Entwicklung einer chronisch entzündlichen Darmerkrankung (CED) hin. Die exklusive enterale Ernährungstherapie (EET) ist das Musterbeispiel einer effektiven Entzündungskontrolle durch eine rein diätetische Intervention. Ausgehend davon haben Patienten, Familien und betreuende Fachkräfte des Gesundheitswesens ein großes Interesse, andere Ernährungsmodifikationen in der Behandlung von CED-Patienten einzusetzen, zum Beispiel eine partielle Ernährungstherapie (PET) mit spezifischer Diät wie die Crohnʼs Disease Exclusion Diet. Die folgende Stellungnahme fasst die aktuelle Datenlage zusammen und gibt Orientierung für Praxis und weitere Forschung.

Abstract

Epidemiological an clinical observations as well as results from animal studies indicate that nutrition can play a role in the development of inflammatory bowel disease (IBD). Exclusive enteral nutrition therapy represents an example for modulating inflammatory responses solely through diet modification. Therefore, caretakers, patients, families, doctors and nutritionists seek for more dietary options to control IBD. These options include partial enteral nutrition therapy as for example the socalled Crohnʼs disease exclusion diet. The following statement summarizes existing data and provides recommendations for the current management of enteral nutrition therapy in pediatric Crohnʼs disease.

Schlüsselwörter

Morbus Crohn - Ernährungstherapie - Ernährungsmedizin - Crohnʼs Disease Exclusion Diet - chronisch entzündliche Darmerkrankung

Key words

Crohnʼs Disease - nutrition therapy - nutrition medicine - Crohnʼs Disease Exclusion Diet - inflammatory bowel disease

Publikationsverlauf

Eingereicht: 10. Mai 2020

Angenommen: 05. Juni 2020

Artikel online veröffentlicht:
18. September 2020

• Literatur

• 1 Khalili H, Chan SSM, Lochhead P. et al. The role of diet in the aetiopathogenesis of inflammatory bowel disease. Nat Rev Gastroenterol Hepatol 2018; 15: 525-535
• 2 Dolan KT, Chang EB. Diet, gut microbes, and the pathogenesis of inflammatory bowel diseases. Mol Nutr Food Res 2017; 61: 10
• 3 Statovci D, Aguilera M, MacSharry J. et al. The Impact of Western Diet and Nutrients on the Microbiota and Immune Response at Mucosal Interfaces. Front Immunol 2017; 8: 838
• 4 Ruemmele FM, Veres G, Kolho KL. et al. Consensus guidelines of ECCO/ESPGHAN on the medical management of pediatric Crohnʼs disease. J Crohns Colitis 2014; 8 (10) 1179-1207
• 5 Miele E, Shamir R, Aloi M. et al. Nutrition in Pediatric Inflammatory Bowel Disease: A Position Paper on Behalf of the Porto Inflammatory Bowel Disease Group of the European Society of Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr 2018; 66: 687-708
• 6 Zachos M, Tondeur M, Griffiths AM. Enteral nutritional therapy for induction of remission in Crohnʼs disease. Cochrane Database Syst Rev 20071: CD000542
• 7 Heuschkel RB, Menache CC, Megerian JT. et al. Enteral nutrition and corticosteroids in the treatment of acute Crohnʼs disease in children. J Pediatr Gastroenterol Nutr 2000; 31: 8-15
• 8 Dziechciarz P, Horvath A, Shamir R. et al. Meta-analysis: enteral nutrition in active Crohnʼs disease in children. Aliment Pharmacol Ther 2007; 26: 795-806
• 9 Grogan JL, Casson DH, Terry A. et al. Enteral feeding therapy for newly diagnosed pediatric Crohnʼs disease: a double-blind randomized controlled trial with two years follow-up. Inflamm Bowel Dis 2012; 18: 246-253
• 10 Buchanan E, Gaunt WW, Cardigan T. et al. The use of exclusive enteral nutrition for induction of remission in children with Crohnʼs disease demonstrates that disease phenotype does not influence clinical remission. Aliment Pharmacol Ther 2009; 30: 501-507
• 11 Rubio A, Pigneur B, Garnier-Lengline H. et al. The efficacy of exclusive nutritional therapy in paediatric Crohnʼs disease, comparing fractionated oral vs. continuous enteral feeding. Aliment Pharmacol Ther 2011; 33: 1332-1339
• 12 Lee D, Baldassano RN, Otley AR. et al. Comparative Effectiveness of Nutritional and Biological Therapy in North American Children with Active Crohnʼs Disease. Inflamm Bowel Dis 2015; 21: 1786-1793
• 13 Pigneur B, Lepage P, Mondot S. et al. Mucosal Healing and Bacterial Composition in Response to Enteral Nutrition Vs Steroid-based Induction Therapy-A Randomised Prospective Clinical Trial in Children With Crohnʼs Disease. J Crohns Colitis 2019; 13: 846-855
• 14 Borrelli O, Cordischi L, Cirulli M. et al. Polymeric diet alone versus corticosteroids in the treatment of active pediatric Crohnʼs disease: a randomized controlled open-label trial. Clin Gastroenterol Hepatol 2006; 4: 744-753
• 15 Werkstetter KJ, Schatz SB, Alberer M. et al. Influence of exclusive enteral nutrition therapy on bone density and geometry in newly diagnosed pediatric Crohnʼs disease patients. Ann Nutr Metab 2013; 63: 10-16
• 16 Afzal NA, Van Der Zaag-Loonen HJ, Arnaud-Battandier F. et al. Improvement in quality of life of children with acute Crohnʼs disease does not parallel mucosal healing after treatment with exclusive enteral nutrition. Aliment Pharmacol Ther 2004; 20: 167-172
• 17 Miele E, Shamir R, Aloi M. et al. Nutrition in Paediatric Inflammatory Bowel Disease: A Position Paper on Behalf of The Porto IBD Group of ESPGHAN. J Pediatr Gastroenterol Nutr 2018; 66: 687-708
• 18 Akobeng AK, Miller V, Stanton J. et al. Double-blind randomized controlled trial of glutamine-enriched polymeric diet in the treatment of active Crohnʼs disease. J Pediatr Gastroenterol Nutr 2000; 30: 78-84
• 19 Ludvigsson JF, Krantz M, Bodin L. et al. Elemental versus polymeric enteral nutrition in paediatric Crohnʼs disease: a multicentre randomized controlled trial. Acta Paediatr 2004; 93: 327-335
• 20 Sakurai T, Matsui T, Yao T. et al. Short-term efficacy of enteral nutrition in the treatment of active Crohnʼs disease: a randomized, controlled trial comparing nutrient formulas. JPEN J Parenter Enteral Nutr 2002; 26: 98-103
• 21 Gassull MA, Fernandez-Banares F, Cabre E. et al. Fat composition may be a clue to explain the primary therapeutic effect of enteral nutrition in Crohnʼs disease: results of a double blind randomised multicentre European trial. Gut 2002; 51: 164-168
• 22 Sylvester FA, Wyzga N, Hyams JS. et al. Natural history of bone metabolism and bone mineral density in children with inflammatory bowel disease. Inflamm Bowel Dis 2007; 13: 42-50
• 23 Lawley M, Wu JW, Navas-Lopez VM. et al. Global Variation in Use of Enteral Nutrition for Pediatric Crohn Disease. J Pediatr Gastroenterol Nutr 2018; 67: e22-e29
• 24 Frivolt K, Schwerd T, Werkstetter KJ. et al. Repeated exclusive enteral nutrition in the treatment of paediatric Crohnʼs disease: predictors of efficacy and outcome. Aliment Pharmacol Ther 2014; 39: 1398-1407
• 25 Svolos V, Hansen R, Nichols B. et al. Treatment of Active Crohnʼs Disease With an Ordinary Food-based Diet That Replicates Exclusive Enteral Nutrition. Gastroenterology 2019; 156: 1354-1367 e6
• 26 Sabino J, Lewis JD, Colombel JF. Treating Inflammatory Bowel Disease With Diet: A Taste Test. Gastroenterology 2019; 157: 295-297
• 27 Cohen SA, Gold BD, Oliva S. et al. Clinical and mucosal improvement with specific carbohydrate diet in pediatric Crohn disease. J Pediatr Gastroenterol Nutr 2014; 59: 516-521
• 28 Olendzki BC, Silverstein TD, Persuitte GM. et al. An anti-inflammatory diet as treatment for inflammatory bowel disease: a case series report. Nutr J 2014; 13: 5
• 29 Prince AC, Myers CE, Joyce T. et al. Fermentable Carbohydrate Restriction (Low FODMAP Diet) in Clinical Practice Improves Functional Gastrointestinal Symptoms in Patients with Inflammatory Bowel Disease. Inflamm Bowel Dis 2016; 22: 1129-1136
• 30 Levine A, Wine E, Assa A. et al. Crohnʼs Disease Exclusion Diet Plus Partial Enteral Nutrition Induces Sustained Remission in a Randomized Controlled Trial. Gastroenterology 2019; 157: 440-450 e8
• 31 Sigall-Boneh R, Pfeffer-Gik T, Segal I. et al. Partial enteral nutrition with a Crohnʼs disease exclusion diet is effective for induction of remission in children and young adults with Crohnʼs disease. Inflamm Bowel Dis 2014; 20: 1353-1360
• 32 Riechmann J, de Laffolie J, Zimmer KP. Restrictive diets are to be avoided. Dtsch Arztebl Int 2014; 111: 148-149
• 33 Sigall Boneh R, Sarbagili ShabatC, Yanai H. et al. Dietary Therapy With the Crohnʼs Disease Exclusion Diet is a Successful Strategy for Induction of Remission in Children and Adults Failing Biological Therapy. J Crohns Colitis 2017; 11: 1205-1212