Diet
The diet should be balanced in patients with Crohn's disease. No special diet has been proven effective for preventing or treating Crohn's disease, but a nutritious diet should be followed, in addition to avoiding any foods that seem to worsen symptoms. Such foods are for example dairy products (in lactose intolerant patients). In these patients osteoporosis is a common nutritional complication, enhanced by the release of cytokines from inflammatory cells, which stimulate osteoclast activity and lead to increased bone breakdown. Corticosteroid use is also another significant risk factor for the development of osteoporosis.
Patients who undergo extensive resection of the terminal portion of the ileum may benefit from a low-fat diet with the addition of medium-chain triglyceride preparations.
Enteral therapy with an elemental diet has been suggested to induce remission in acute Crohn's disease. Consumption of at least 1200 kcal/day was associated with lower rates of disease relapse, but patients' conditions have frequently relapsed after initiation of a normal diet (Harpavat M et al, 2004Harpavat M, Keljo DJ, Regueiro MD. Metabolic bone disease in inflammatory bowel disease. J Clin Gastroenterol. Mar 2004;38(3):218-24.; Heuschkel R et al, 2004Heuschkel R. Enteral nutrition in Crohn disease: more than just calories. J Pediatr Gastroenterol Nutr. Mar 2004;38(3):239-41; Razack R et al, 2007Razack R, Seidner DL. Nutrition in inflammatory bowel disease. Curr Opin Gastroenterol. Jul 2007;23(4):400-5.).
Total parenteral nutrition is applied in Crohn's disease in some circumstances: in patients with active inflammation and severe malnutrition and those with fistulae (given preoperatively, on short term), in patients who have had extensive intestinal resection, resulting in short bowel syndrome (long term use), or in patients with fistulae in order to put bowel at rest during the healing.
Probiotics are as living microorganisms, which, upon ingestion in certain numbers, may exert heath effects beyond basic nutrition. Although studies have shown some promising results, there is insufficient evidence to make any conclusions about the efficacy of probiotics for induction of remission in Crohn's disease. There is a lack of well designed trials in this area and further research is needed (Butterworth AD, 2009)Butterworth AD, Thomas AG, Akobeng AK. Probiotics for induction of remission in Crohn's disease. Cochrane Database Syst Rev. 2008 Jul 16;(3).