What question did this study set out to answer?

This study aims to compare the clinical outcomes of Crohn’s disease exclusion diet and exclusive enteral nutrition in pediatric patients.

July 5, 2026Open Access

Comparison of Crohn’s disease exclusion diet and exclusive enteral nutrition in prospectively followed paediatric patients with Crohn’s disease

Key Points

This study aims to compare the clinical outcomes of Crohn’s disease exclusion diet and exclusive enteral nutrition in pediatric patients.
Implemented Crohn’s Disease Exclusion Diet in January 2020 for induction in newly diagnosed patients with PCDAI ≤ 40.
Included children induced with Enteral Nutrition from 2014 to 2017 as a reference group.
Prospectively assessed clinical response and mucosal healing at week 6, and clinical relapse within the first year.
Clinical response observed in 76% of CDED and 82% of EEN groups (aOR 0.56, 95% CI 0.08–3.50).
Mucosal healing achieved in 48% of CDED and 33% of EEN with no significant association with induction type (aOR = 1.74, 95% CI 0.51–6.13).
CDED associated with lower relapse risk (HR = 0.56, 95% CI 0.32–0.99), but did not remain significant after adjustment.

Abstract

Abstract Background Crohn’s Disease exclusion diet (CDED) has been associated with positive outcomes in paediatric Crohn’s disease (CD) remission induction. This study prospectively compared clinical outcomes of CDED versus exclusive enteral nutrition (EEN). Methods CDED was implemented in January 2020 for induction in newly diagnosed CD patients with paediatric CD activity index (PCDAI) ≤ 40. Children induced with EEN (2014–2017) were included as a reference group. Clinical response (PCDAI decrease of 12.5 or 500 µg/g. Results This study included 66 patients, 33 in each group, with significantly higher baseline PCDAI in the EEN group. Clinical response, observed in 76% of children on CDED and 82% receiving EEN, yielded aOR of 0.56 (95% CI = 0.08–3.50) for CDED vs EEN. Mucosal healing, achieved in 48% of children on CDED and 33% of EEN patients, was not associated with induction type (aOR = 1.74 95% CI = 0.51–6.13). CDED was associated with lower relapse risk (HR = 0.56 95% CI = 0.32–0.99); did not remain after adjustment. Conclusion CDED was not associated with less favourable clinical outcomes compared to EEN induction. Impact Exclusive enteral nutrition (EEN) is a well-established induction therapy for children with mild to moderate Crohn’s disease (CD), with tolerance representing one of its main limitations. In this prospective comparison of Crohn´s Disease Exclusion Diet (CDED) and EEN in newly diagnosed paediatric patients, CDED was not associated with significantly worse clinical outcomes compared to EEN. In routine clinical practice, CDED appears to be a suitable induction treatment option for children with mild to moderate CD, with outcomes comparable to EEN.

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