Practical application of the Crohn's disease exclusion diet as therapy in an adult Australian population

Journal article


Russell, Erin E., Day, Alice Sarah, Dimitroff, Claire, Trakman, Gina L., Silva, Hannah, Bryant, Robert V., Purcell, Liz, Yao, Chu K., Landorf, Emma and Fitzpatrick, Jessica A.. (2024). Practical application of the Crohn's disease exclusion diet as therapy in an adult Australian population. Journal of Gastroenterology and Hepatology. 39(3), pp. 446-456. https://doi.org/10.1111/jgh.16414
AuthorsRussell, Erin E., Day, Alice Sarah, Dimitroff, Claire, Trakman, Gina L., Silva, Hannah, Bryant, Robert V., Purcell, Liz, Yao, Chu K., Landorf, Emma and Fitzpatrick, Jessica A.
Abstract

There is demand from patients and clinicians to use the Crohn's disease exclusion diet (CDED) with or without partial enteral nutrition (PEN). However, the therapeutic efficacy and nutritional adequacy of this therapy are rudimentary in an adult population. This review examines the evidence for the CDED in adults with active luminal Crohn's disease and aims to provide practical guidance on the use of the CDED in Australian adults. A working group of nine inflammatory bowel disease (IBD) dietitians of DECCAN (Dietitians Crohn's and Colitis Australian Network) and an IBD gastroenterologist was established. A literature review was undertaken to examine (1) clinical indications, (2) monitoring, (3) dietary adequacy, (4) guidance for remission phase, and (5) diet reintroduction after therapy. Each diet phase was compared with Australian reference ranges for food groups and micronutrients. CDED with PEN is nutritionally adequate for adults containing sufficient energy and protein and meeting > 80% of the recommended daily intake of key micronutrients. An optimal care pathway for the clinical use of the CDED in an adult population was developed with accompanying consensus statements, clinician toolkit, and patient education brochure. Recommendations for weaning from the CDED to the Australian dietary guidelines were developed. The CDED + PEN provides an alternate partial food-based therapy for remission induction of active luminal Crohn's disease in an adult population. The CDED + PEN should be prioritized over CDED alone and prescribed by a specialist IBD dietitian. DECCAN cautions against using the maintenance diet beyond 12 weeks until further evidence becomes available.

KeywordsCrohn's disease; diet therapy; IBD; nutrition
Year2024
JournalJournal of Gastroenterology and Hepatology
Journal citation39 (3), pp. 446-456
PublisherJournal of Gastroenterology and Hepatology Foundation
John Wiley & Sons Australia, Ltd
ISSN0815-9319
Digital Object Identifier (DOI)https://doi.org/10.1111/jgh.16414
PubMed ID38059536
Scopus EID2-s2.0-85178879483
Open accessPublished as ‘gold’ (paid) open access
Page range446-456
Publisher's version
License
File Access Level
Open
Output statusPublished
Publication dates
Online07 Dec 2023
Publication process dates
Accepted30 Oct 2023
Deposited30 Jun 2025
Additional information

© 2023 The Authors. Journal of Gastroenterology and Hepatology published by Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

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OA_Russell_2024_Practical_application_of_the_Crohns_disease.pdf
License: CC BY-NC-ND 4.0
File access level: Open

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