THE DIETARY-MANAGEMENT OF CROHNS-DISEASE

Enteral feeding has been shown to be as effective as primary therapy f or Crohn's disease, but it requires high patient motivation, may be un palatable and is expensive, However, in adolescents with growth failur e and when corticosteroid therapy is contra-indicated or has failed, i t may become the treatment of choice. Furthermore, dietary therapy all ows circumvention of the adverse side-effects of repeated courses of s teroids, A number of different hypotheses have been proposed to explai n the effect of enteral feeds but none has reached universal acceptanc e, Prospective trials suggest that the exclusion of whole protein is n ot necessary. Comparison of feeds with differing composition suggests that a low fat content increases efficacy and various explanations hav e been offered. The reduction of colonic bacterial load may also be im portant. Because symptoms of Crohn's disease may be provoked by eating , there is a risk of falsely attributing symptoms to specific foodstuf fs, However, in many individuals foods can be identified which affect disease activity, and their exclusion leads to prolongation of disease remission. Dietetic supervision during food testing is important to a void detrimental effects on nutrient and micronutrient intake.