The importance of nutritional therapy in the treatment of Crohn's disease in the paediatric population

Abstract

Crohn's disease is one of the inflammatory bowel diseases that is chronic and inflammatory potential. The course of Crohn's disease in children is usually more severe than in adults. The most common symptoms are abdominal pain and chronic diarrhea. Limited food intake, malabsorption and increased excretion often lead to malnutrition and nutritional deficiencies in pediatric patients. The development of Crohn's disease depends on genetic, microbiological and environmental factors that lead to intestinal dysbiosis and abnormal activation of the intestinal immune system. An anti-inflammatory diet plays an important role in disease prevention. It's characterized by a high content of products rich in anti-inflammatory food ingredients, such as: antioxidant vitamins, polyphenols, polyunsaturated fatty acids omega-3, monounsaturated fatty acids, dietary fiber and vitamin D. The anti-inflammatory diet is also characterized by a low content of products rich in pro-inflammatory food ingredients, including: saturated fatty acids, trans fatty acids, simple sugars, alcohol, salt, as well as some emulsifiers, preservatives and artificial sweeteners. The position paper on the therapeutic management of children with Crohn's disease was developed by pediatric section of the European Crohn’s and Colitis Organization and The European Society of Paediatric Gastroenterology, Hepatology and Nutrition. One of the main therapeutic goals of Crohn's disease of children is to achieve and maintain clinical and deep intestinal mucosal remission. Treatment for Crohn's disease consists of remission-inducing therapy and remission-maintaining therapy. Remission-inducing therapies include: nutritional therapy, steroid therapy and anti-TNF-alpha biological therapy. Whereas remission-maintaining therapies include: immunosuppressive therapy, anti-TNF-alpha biological therapy and nutritional therapy. The first chosen therapeutic method in achieving remission of Crohn's disease in children, located in the ileocecal and colonic region is the introduction of total enteral nutrition for 6-8 weeks. Whereas the first chosen therapeutic method in maintain remission is anti-TNF-alpha biologic therapy or combination therapy with anti-TNF-alpha with immunosuppressive treatment. The Crohn's Disease Exclusion Diet combined with partial enteral nutrition shows comparable therapeutic potential for remission induction to exclusive enteral nutrition, as well as promising therapeutic potential for maintenance of remission. The purpose of this diet is reduce the exposure of patients to food components that may adversely affect on the intestinal immunity. The aim of the study is to systematization of available knowledge on the impact of enteral nutrition and oral diet in children for achieving remission.

Keywords

• diet therapy
• nutritional treatment
• crohn’s disease in children
• inflammatory bowel diseases in children
• crohn’s disease exclusion diet