Inflammatory Bowel Disease

Standard care for IBD
Conventional treatment is aimed at reducing inflammation and maintaining remission. It usually involves drugs or surgery and is not considered curative. Surgery usually involves removing inflamed portions of the GI tract. Anti-diarrheal and pain medications may be used in some cases. Non-steroidal anti-inflammatory drugs are the most common types of drugs used to treat IBD. Immunosuppressants may be used in severe cases.¹ 

Elemental diet for dietary management of IBD

Key features in elemental diet formulations provide complete nutrition in an easily assimilated form that allows the gut to rest and recuperate while patients regain comfort and control. Among the proposed mechanisms of action, elemental diets are thought to reduce the work of digestion, decrease abnormal intestinal permeability, lower dietary antigens, reduce inflammatory cytokines, and beneficially alter the intestinal microbiome.² 

Clinical studies using elemental diets for dietary management of IBD

Research has shown that elemental diets can be effective in the nutritional management of IBD. In one controlled clinical study, 28 patients with active Crohn’s disease were placed on an elemental diet for four weeks with no other food or medication. Clinical remission was achieved in 71% of cases. Intestinal biopsies also showed reduced production of inflammatory cytokines and a corrected balance between pro- and anti-inflammatory cytokine levels from the elemental diet.³ A randomized controlled trial comparing the effectiveness of corticosteroids and an elemental diet over periods of four and 12 weeks in 21 patients acutely ill with exacerbations of Crohn's disease found that patients treated with the elemental diet had improved as much as and by some criteria more than the steroid treated group.⁴ Similarly, another randomized controlled study found that an elemental diet was at least as effective as corticosteroid drug treatment over a period of four weeks in 42 patients with active Crohn’s.⁵ Some studies have shown that an elemental diet can also be effective for ulcerative colitis. A clinical trial in 23 ulcerative colitis patients found that 56% achieved remission on an elemental diet and 46% of these remained in remission for 7 to 28 months.⁶ 

Diagnosis & testing

Diagnosis of IBD often involves ruling out other conditions that may have similar symptoms, including colon cancer, IBS, SIBO, food intolerances, or intestinal infection. Commonly used tests include complete blood count (CBC) to rule out anemia, as well as high-sensitivity C-reactive protein in the blood and calprotectin in stool to measure inflammation. Diagnostic imaging procedures may be involved in some cases (X-ray, CT scan, MRI). Scoping procedures (colonoscopy, sigmoidoscopy, endoscopy) and microscopic biopsy are used for definitive diagnosis.⁷ 

References

1. Mayo Clinic. “Inflammatory Bowel Disease: Diagnosis & Treatment.” March 2020. https://www.mayoclinic.org/diseases-conditions/inflammatory-bowel-disease/diagnosis-treatment/drc-20353320

2. Ciampa, B., Ramos, E., et al (2017) The emerging therapeutic role of medical foods for gastrointestinal disorders. Gastroenterol Hepatol, 13: 104-115.

3. Yamamoto, T., Nakahigashi, M., Umegae, S., Kitagawa, T. and Matsumoto, K. (2005), Impact of elemental diet on mucosal inflammation in patients with active Crohn's disease: Cytokine production and endoscopic and histological findings. Inflamm Bowel Dis, 11: 580-588

4. O’Morain, C., Segal, AW., Levi, AJ. (1984) Elemental diet as primary treatment of acute Crohn’s disease: a controlled trial. Br Med J (Clin Res Ed). 1859-62.

5. Gorard, DA., Hunt, JB., Payne-James, JJ. Et al. (1993) Initial response and subsequent course of Crohn’s disease treated with elemental diet or prednisone. Gut. 1198-202.

6. Axelsson, C., Jarnum, S. (1977) Assessment of the therapeutic value of an elemental diet in chronic inflammatory bowel disease. Scand J Gastroenterol, 89-95.

7. Mayo Clinic. “Inflammatory Bowel Disease: Diagnosis & Treatment.” March 2020. https://www.mayoclinic.org/diseases-conditions/inflammatory-bowel-disease/diagnosis-treatment/drc-20353320