Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 14, 2016; 22(6): 2111-2117
Published online Feb 14, 2016. doi: 10.3748/wjg.v22.i6.2111
Response to strict and liberalized specific carbohydrate diet in pediatric Crohn’s disease
Jennifer C Burgis, Kaylie Nguyen, KT Park, Kenneth Cox
Jennifer C Burgis, Kaylie Nguyen, KT Park, Kenneth Cox, Department of Pediatrics, Gastroenterology, Hepatology and Nutrition, Stanford University School of Medicine, Palo Alto, CA 94304, United States
Author contributions: Burgis JC, Nguyen K, Park KT and Cox K contributed equally to this work; Burgis JC, Nguyen K, Park KT and Cox K designed the research; Burgis JC, Nguyen K, Park KT and Cox K performed the research; Burgis JC and Park KT analyzed the data; Burgis JC, Nguyen K, Park KT and Cox K wrote the paper.
Supported by George Serrurier through the Lucile Packard Foundation for Children’s Health. KT Park is supported by the National Institutes of Health, No. K08 DK094868.
Institutional review board statement: This study was reviewed and approved by the Stanford University Human Subjects Research Institutional Review Board.
Informed consent statement: As a retrospective review, a waiver of consent was granted by the Stanford University Human Subject Research Institutional Review Board for all study participants per the requirement that the research involved no more than minimal risk to the subjects, the waiver will not adversely affect the rights and welfare of the subjects, the research could not be practicably carried out without the waiver and pertinent information when appropriate will be provided after participation.
Conflict-of-interest statement: There are no conflicts of interest to disclose.
Data sharing statement: A waiver of authorization was granted by the Stanford University Human Subject Research Institutional Review Board and all data was obtained from internal records review. Dataset available from the corresponding author at jburgis@stanford.edu.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jennifer C Burgis, MD, Clinical Assistant Professor, Department of Pediatrics, Gastroenterology, Hepatology and Nutrition, Stanford University School of Medicine, 750 Welch Road, Suite 116, Palo Alto, CA 94304, United States. jburgis@stanford.edu
Telephone: +1-650-7235070 Fax: +1-650-4985608
Received: May 19, 2015
Peer-review started: May 20, 2015
First decision: July 19, 2015
Revised: August 18, 2015
Accepted: September 28, 2015
Article in press: September 30, 2015
Published online: February 14, 2016
Processing time: 249 Days and 13.6 Hours
Abstract

AIM: To investigate the specific carbohydrate diet (SCD) as nutritional therapy for maintenance of remission in pediatric Crohn’s disease (CD).

METHODS: Retrospective chart review was conducted in 11 pediatric patients with CD who initiated the SCD as therapy at time of diagnosis or flare. Two groups defined as SCD simple (diet alone, antibiotics or 5-ASA) or SCD with immunomodulators (corticosteroids and/or stable thiopurine dosing) were followed for one year and compared on disease characteristics, laboratory values and anthropometrics.

RESULTS: The mean age at start of the SCD was 11.8 ± 3.0 years (range 6.6-17.6 years) with five patients starting the SCD within 5 wk of diagnosis. Three patients maintained a strict SCD diet for the study period and the mean time for liberalization was 7.7 ± 4.0 mo (range 1-12) for the remaining patients. In both groups, hematocrit, albumin and ESR values improved while on strict SCD and appeared stable after liberalization (P-value 0.006, 0.002, 0.002 respectively). The majority of children gained in weight and height percentile while on strict SCD, with small loss in weight percentile documented with liberalization.

CONCLUSION: Disease control may be attainable with the SCD in pediatric CD. Further studies are needed to assess adherence, impact on mucosal healing and growth.

Keywords: Specific carbohydrate diet; Crohn’s disease; Pediatrics; Nutrition therapy

Core tip: Enteral nutrition is effective for both induction and maintenance therapy for pediatric Crohn’s disease (CD), but adherence to a formula-based diet can be challenging. The specific carbohydrate diet (SCD) may offer a real-food nutritional therapy. Mild liberalization after response to a strict diet has not been described and may improve adherence while maintaining therapeutic effect. Laboratory parameters improved when following a strict SCD and were stable after liberalization. Despite this restrictive diet, growth was supported. The SCD may offer an alternative or adjunct to traditional medication therapy for pediatric CD.