THE DEVELOPMENT AND EVALUATION OF A DIET FOR MAINTAINING REMISSION INCROHNS-DISEASE

Background: Elimination diets have been used in Crohn's disease to hel p maintain remission following enteral feeding. However, patients ofte n God the strict regimen difficult to follow resulting in poor complia nce. This paper describes the development and evaluation of an alterna tive method of food re-introduction, a low-fibre, fat-limited exclusio n diet or 'LOFFLEX' diet. Methods: Patients achieving remission on an elemental or peptide feed or total parenteral nutrition (TPN) chose to follow either an elimination or LOFFLEX diet. Their progress was asse ssed regularly and life-analysis tables used to calculate remission ra tes for the two groups at the end of a 2-year period. Results: In a se ries of 76 treatment episodes (74 patients having achieved remission o n an enteral feed, two on TPN), 28 patients (37%) chose the eliminatio n diet and 48 (63%) the LOFFLEX diet. Fourteen per cent failed to comp ly with the elimination diet and 8% failed to comply with the LOFFLEX diet. Eleven per cent of the elimination group and 12.5% of the LOFFLE X group relapsed immediately and were all found to have tight strictur es. At 24 months, the proportion of compliant, non-strictured patients still in remission was 59% for the elimination diet and 56% for the L OFFLEX diet. Conclusion: This study suggests that the LOFFLEX diet bas s similar efficacy to the elimination diet whilst being more acceptabl e to the patient. A randomized, prospective controlled study is now un derway to further investigate these findings.