Role of diet in the management of inflammatory bowel disease

Table 1 Reviewed studies looking at dietary exclusion and sensitivity to foods

Ref.	Trial type	No. of patients	Diets compared	Findings	Outcomes/measures	GRADE rating
Voitk et al[4]	Retrospective	13	Elemental diet	Patients with UC. Showed improved weight and positive nitrogen balance	Weight, nitrogen balance and nutritional state	1D
Borrelli et al[10]	Open RCT	38	Oral steroid vs polymeric feed only	Clinical remission comparable (67% steroid group, 79% polymeric group). Significantly improved histological and endoscopic scores in the polymeric group	Clinical remission, histological and endoscopic scores at 10 wk	1A
Riordan et al[13]	Multicentre double blinded RC	136	Exclusion diet vs steroid treatment	Patients were maintained in remission on exclusion diets	Hemoglobin, albumin, ESR, CRP, remission rates over 2 yr	1A
Jones et al[14]	Controlled trial	20	Unrefined carbohydrate rich diet vs exclusion diet	7 out of 10 on the exclusion diet remained in remission for 6 mo vs none of the other group	Clinical remission
Pearson et al[16]	Prospective cohort	42	Food intolerances after remission induced with enteral feeding	20 patients identified food intolerances and eight did not. 14 did not complete the study	Food intolerances were found in CD but were variable and short-lived	2C
Greenberg et al[17]	RCT	51	TPN vs formula diet via NG vs partial parenteral and oral food	Clinical remission in 71% of parenteral group, 60% of partial parenteral group and 58% defined formula group	Relapse rates, weight, albumin, arm circumference, triceps skinfold thickness	1B
Jones et al[19]	Randomised	36	TPN vs elemental for induction of remission in CD	Both were successful with no significant differences. Elemental diet was cheaper, safer and simpler	CDAI, ESR and serum albumin	2B
Sanderson et al[20]	RCT	17 children	Elemental via NG for 6 wk vs high dose steroids	Elemental feed equally effective in children to high dose steroids. Linear growth better in elemental group over 6 mo	Lloyd-Still score, ESR, CRP, albumin, linear growth and body weight	2A
Wilschanski et al[29]	Retrospective	65	Nasogastric supplemental feeding	Continued nasogastric feeding post resumption of normal diet maintained remission for longer and showed improved linear growth	Relapse rate, linear growth	1D
Esaki et al[31]	Retrospective	145	Enteral vs non enteral (where enteral applies to elemental or polymeric feeds)	Enteral feeding showed a lower relapse rate than non-enteral	Rate of relapse based on CDAI scores	1D
Axelsson et al[33]	Cohort	34	Elemental diet for IBD refractory to improvement on high dose steroids	31 had been on high dose steroids prior to trial. 15 went into remission on elemental feed alone. 6 achieved remission with introduction or increase in prednisone dose	Serum iron, transferring, albumin, creatinine clearance, ESR, urea clearance, fecal volume, number of bowel movements	1B
Ballegaard et al[36]	Questionnaire	130		Sensitivity was commonly reported to vegetables (40%), fruit (28%), milk (27%), meat (25%) and bread (23%). No differences were found between the UC and CD groups		1C
Brandes et al[44]	RCT	20	Refined sugar rich vs refined sugar excluded	The sugar rich diet was stopped in 4 patients due to flare-ups. In those with mild disease there were no detrimental effects in either group	CDAI	2B
Van den Bogaerde et al[45]	Case-control study	31 CD, 22 controls	Peripheral lymphocytes were incubated with food and bacterial antigens	Lymphocyte proliferation to all food and bacterial antigens was higher in CD patients than controls	Lymphocyte proliferation	1C
Van den Bogaerde et al[46]	Case-control study	10 CD, 10 controls	Skin testing and rectal exposure to 6 food antigens	CD patients had significant in vivo and in vitro sensitization to food antigens which is gut specific	In vivo - rectal blood flow. In vitro - lymphocyte proliferation	1C