Group 3 (UCED alone) showed the highest rate of clinical remission (40%) and endoscopic remission (27%). Group 3 also demonstrated a significant decrease in the Simple Clinical Colitis Activity Index (SCCAI) at week 8. A significant proportion of patients worsened after FT (Group 1 or Group 2) by week 8 compared to baseline. Group 3 reported the least worsening of disease. D Chan, et al. Inflammatory bowel disease and exercise: results of a Crohn's and Colitis UK survey. Frontline Gastroenterol. 2014 Jan;5(1):44-48.

of Gastroenterology and Hepatology, Chinese People's Liberation Army General Hospital, Beijing, ChinaYanai H, Levine A, et al. The Crohn’s Disease Exclusion Diet for induction and maintenance of remission in adults with mild-to-moderate Crohn’s disease (CDED-AD). Lancet Gastroenterol Hepatol. 2022 Jan;7(1):49-59. Patient selection for CDED is important. For complex fistulating disease, EEN would still be the first line, but CDED can be considered if the patient is stable enough without the presence of abscesses, usually after an initial period of EEN. If a patient presents with tight inflammatory strictures or a bowel obstruction, EEN would also be considered as the first line. However, with small adaptions, CDED can still be used once inflammation reduces.

Your diet can be helpful in managing your inflammatory bowel disease (IBD) during flares and periods of remission. Your healthcare team, including a registered dietitian specializing in IBD, may recommend a particular diet based on your symptoms. Poate fi folosit ca sursă unică de nutriție în faza acută a bolii Crohn sau pentru completarea alimentației în perioadele de remisie;

Introduction

Group 1 received a free diet and a single donor standard fecal transplant (FT) by colonoscopy on day 1 and rectal enemas on days 2 and 14 without dietary conditioning of the donor. Consumption of dietary fibre was associated with reduced disease flares in patients with CD but not UC. 77 Recommendations to limit dietary fibre, as proposed in the low-residue diet often prescribed in patients with diarrhoea to enhance digestive comfort should be re-evaluated. CSs may be a kind of treatment selection for patients with UC who have not responded to mesalazine within 2–4 weeks, and those with mild-to-moderate CD, especially with extensive lesions ( 28). CSs have no proven efficacy in maintaining remission in IBD and should not be used for this purpose. Systemic oral CSs may result in numerous side effects, such as opportunistic infections, diabetes mellitus, hypertension, ocular effects, venous thromboembolism (VTE), osteoporosis, etc ( 29, 30). Steroid dependency or excess was found in ~15–40% of IBD patients ( 31, 32). Further investigation should define appropriate corticosteroid use and find measures for the improvement in CSs prescription management.

Another important role for enteral nutrition is in the perioperative setting, to help improve surgical outcomes for patients with IBD. In these studies, a diet of EEN prior to surgery can be associated with improved nutritional status, reduced length of surgery, and lower rate of complications such as infection. sirop de glucoză, cazeină ( lapte), sucroză, grăsimi din lapte, ulei vegetal de cocos, minerale (citrat de potasiu, fosfat de calciu, citrat de sodiu, carbonat de calciu, clorură de magneziu, hidroxid de potasiu, clorură de potasiu, sulfat feros, sulfat de zinc, oxid de magneziu, sulfat de mangan, sulfat de cupru, molibdat de sodiu, iodură de potasiu, clorura de crom, selenat de sodiu), ulei vegetal de porumb, emulgator (lecitine) (conține soia), vitamine [ascorbat de sodiu (vitamina C), acetat de DL-alfa-tocoferil (vitamina E), niacina, adic pantotenic, clorhidrat de piridoxina (vitamina B6), mononitrat de tiamină (vitamina B1), acetat de retinil (vitamina A), riboflavina (vitamina B2), acid folic, filochinona (vitamina K1), biotina, colecalciferol (vitamina D3), cianocobalamină (vitamina B12)], bitartrat de colină. The next stage was to investigate whether CDED can be used to treat adults with CD, patients with severe luminal CD, therapy for longer than 12 weeks and for patients refractory to biologics and/or as an adjuvant therapy to biologics. Sarbagili Shabat C, Scaldaferri F. A Novel UC exclusion diet and antibiotics for treatment of mild to moderate pediatric ulcerative colitis: A prospective open-label pilot study. Nutrients. 2021 Nov; 13(11): 3736. Another mechanism of dietary interaction with the host is via a direct effect on the immune system, where dietary antigens by themselves may trigger an immune response. The typical western-style diet, high in sugar and saturated fats and low in fibre, can lead to systemic low-grade inflammation, as described in obesity. 25 In animal models, the consumption of milk-derived saturated fats alters bile acid composition, allowing for a bloom of sulphate-reducing bacteria, which in turn can produce greater amounts of the potentially mucosal toxic hydrogen sulphide and production of helper T cell (Th1) proinflammatory cytokines. 26Scarallo L et al., Crohn’s Disease Exclusion Diet in children with Crohn’s disease: a case series. CMRO. 2021, Volume 37, Issue 5. The rationale behind using UCED with PEN is: to support dietary intake with an oral liquid formula (pilot studies showed a decreased energy intake), to provide balance of micro- and macronutrients, to increase adherence and efficacy, to help deliver optimal fiber, and to help personalize recommendations. IL-12 and IL-23 are important pro-inflammatory cytokines in intestinal inflammation, mainly produced by antigen-presenting cells. IL-12 is composed of the p35 and p40 subunits, and IL-23 is composed of the p40 and p19 subunits. Preclinical studies have suggested that IL-12 and IL-23 are involved in the pathophysiological process of IBD and play a role in the induction and maintenance of intestinal inflammation ( 82). In addition, genomic studies have shown an association between the IL-12/IL-23 pathway and CD ( 83).

There is also emerging evidence of the effectiveness of CDED in adults. 21,22 To further consolidate these findings a new multicentric RCT, the PARADISE study, has been initiated to explore CDED+PEN vs prednisone for induction of remission in adult CD patients. Diets for the management of IBD: Where we stand and future perspectivesGroup 2 received FT as above but with dietary preconditioning of the donor for 14 days and a UCED for the patients. Matuszczyk et al., Effect of the Crohn’s Disease Exclusion Diet (CDED) on the fecal calprotectin level in children with active Crohn’s disease. J Clin Med. 2022, 11, 4146 Dietă completă din punct de vedere nutrițional, pe bază de cazeină, pentru regimul dietetic al pacienților cu boala Crohn. Cutie metalică cu capac de plastic cu închidere ermetică, conținând pudră 400 g ce se reconstituie cu apă ca soluție standard normocalorică sau hipercalorică. A 2019 randomized control study, first presented at ECCO, has helped to establish the general principles of the CDED. 23 Food diversity offered within CDED is particularly well appreciated by patients and provides motivation for complying with the treatment. Access to support material and multiple recipes through the Modulife App is an asset for patients, and the latter reduce monotony. New perspectives in dietary management of Ulcerative Colitis