Dietary Factors in the Modulation of Inflammatory Bowel Disease Activity

Shinil Shah, DO, PGY-1

Disclosures

March 27, 2007

Elemental Diets

Elemental diets have been used widely in the treatment of inflammatory bowel disease, especially with the management of Crohn's disease. These diets provide all essential nutrients, and contain protein in the form of free amino acids. These diets require no digestion, and theoretically are easily absorbed.[6]

There are several proposed mechanisms as to the efficacy of this therapy, including elimination of antigens present in food that may provoke an inflammatory response, alternation of the bacterial environment in the colon, and/or a reduction in dietary fat, which some believe may provoke inflammation (explained in more detail later).[6,7]

Elemental diets have been shown to be effective in inducing and maintaining remission, although patients frequently relapse once this therapy is halted. While they have been shown to be superior to placebo,[15] there is controversy as to whether the efficacy of this therapy is equivalent to steroid therapy. Several meta-analyses have shown corticosteroids to be superior to elemental diets in relation to efficacy in the management of IBD.[3,8,9]

In selected cases, however, elemental diet therapy may be a viable option for patients. This may be true in children and adolescents, who may experience stunted growth as a result of high-dose corticosteroid therapy.[10] The major drawback to this therapy is the fact that these diets are often unpalatable and may result in diarrhea as a result of their high osmolarity.[6] These are possible reasons why microparticle-free diets may represent a more viable alternative, if inflammatory bowel disease activity is indeed influenced by the amount of antigens presented to the intestinal immune system.[3]

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