TREATMENT OF ACTIVE CROHNS-DISEASE BY EXCLUSION DIET - EAST ANGLIAN MULTICENTER CONTROLLED TRIAL

Elemental diet is as effective in producing remission of Crohn's disea se (CD) as is corticosteroid treatment, but most patients relapse soon after resumption of a normal diet. We have investigated the efficacie s of dietary modification and oral corticosteroids in maintaining remi ssion achieved with elemental diet. In a multicentre trial, 136 patien ts with active CD were started on elemental diet and other treatment w as withdrawn. 43 (31%) declined to continue elemental diet for 14 days , but 78 (84%) of the remaining 93 achieved remission and were randoml y assigned corticosteroids (38) or diet (40). Corticosteroid treatment started at 40 mg prednisolone daily, which was tapered and stopped af ter 12 weeks; that group received dietary advice on healthy eating. Th e diet group received ''tapered'' placebo and were instructed to intro duce one new food daily, excluding any that precipitated symptoms. Ass essment of progress for up to 2 years was made by physicians unaware o f group assignment. Intention-to-treat analysis showed median lengths of remission of 3.8 (interquartile range 5.0) months in the corticoste roid group and 7.5 (15.3) months on diet, and relapse rates at 2 years , adjusted for withdrawals, of 79% and 62%, respectively (p=0.048). Cl inical improvement in the diet group was associated with significant c hanges in plasma albumin and alpha1-antichymotrypsin concentrations an d erythrocyte sedimentation rate. Food intolerances discovered were pr edominantly to cereals, dairy products, and yeast. Diet provides a fur ther therapeutic strategy in active Crohn's disease.