Sigall-Boneh R.: Active Crohn’s Disease
We hear today in our ESPGHAN podcast from Dr Rotem Sigall-Boneh of Israel’s Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children’s Medical Centre, Petach-Tikva, and the Faculty of Medicine, Tel Aviv University, Tel Aviv – sorry, the “Dr” is a few months away ; she’s earning a PhD (University of Amsterdam), and it’s in the bag, I expect – who has spent the last decade approaching the question of how exclusionary diets exert their beneficial effect in patients with inflammatory bowel disease (IBD), particularly Crohn disease. She asks us to consider : What is the rôle of diet in IBD treatment ? What is the rôle of the dietitian in IBD treatment ? Can IB outcomes be changed by changing the diet? What are the key messages for diet in IBD care?
Ms Sigall-Boneh has contributed substantially to randomised clinical trials studying the effects of exclusionary diets, with partial enteral alimentation, in ameliorating clinical IBD. Such diets can achieve patient-reported favourable results within three weeks of inception, matched by drops in faecal calprotectin values . . . but they’re hard to adhere to. Refining these diets has been her goal, that is, making adhesion practical. The diets differ over time, with phases of inception, stabilisation, and retention, which in the last – she hopes – will be a boon conferred on the patient for life, as a result of training in how to eat better. This approach has a rôle to play in combination with biologic / pharmacologic therapies, restoring a response to medication in treatment failure with anti-tumour necrosis factors (reduced inflammation, improved nutritional status with resolution of hypoalbuminaemia) and improving the degree of response in partial responders. This can be tracked by microbiome status – microbiome composition shifts using the Crohn’s-disease diet, and shifts back again with re-introduction of “free diet” eating. In short, a powerful set of arguments for closely involving dietary management in caring for IBD patients.
Literature :
Levine A et al. Crohn's disease exclusion diet plus partial enteral nutrition induces sustained remission in a randomized controlled trial. Gastroenterology 2019 Aug 157(2):440-450.e8. doi: 10.1053/j.gastro.2019.04.021. Epub 2019 Jun 4. PMID : 31170412
Sigall Boneh R et al. Clin Gastroenterol Hepatol 2021 Apr 19(4):752-759. Dietary therapies induce rapid response and remission in pediatric patients with active Crohn's disease. doi: 10.1016/j.cgh.2020.04.006. Epub 2020 Apr 14. PMID : 32302709
Sigall Boneh R et al. The Crohn's disease exclusion diet: A comprehensive review of evidence, implementation strategies, practical guidance, and future directions. Inflamm Bowel Dis 2023 Nov 18:izad255. doi: 10.1093/ibd/izad255. PMID : 37978895
Dr. Sigall-Boneh´s favourite song: Hurricane - Eden Golan: https://open.spotify.com/track/2Ozw7k5CLtM5W9SomrOyjw?si=452d561a36e54f60
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