Exploring the efficacy and future prospects of nutritional and dietary therapies in Crohn's disease.

Abstract

Introduction: Nutritional therapy has progressed from supportive care to a targeted strategy in inflammatory bowel disease (IBD), particularly Crohn's disease (CD). Exclusive enteral nutrition (EEN) is firmly established as a first-line induction therapy in pediatric CD, achieving remission rates comparable to corticosteroids while simultaneously supporting growth and promoting mucosal healing.

Areas covered: This review outlines enteral and dietary interventions in CD. A PubMed (MEDLINE) search identified relevant studies on nutritional and dietary interventions in CD published up to 17 August 2025. In children, EEN is validated; in adults, its use is more selective, with evidence supporting benefit in mild-to-moderate disease, intolerance to pharmacologic agents, and perioperative optimization. Elemental or low-residue formulas are particularly relevant for patients with stricturing disease or malnutrition. Partial enteral nutrition and structured exclusion diets, such as the Crohn's Disease Exclusion Diet (CDED), offer feasible long-term approaches. Regional differences persist, as Japan has established reimbursement pathways facilitating enteral nutrition, whereas Western countries generally prioritize pharmacologic therapies.

Expert opinion: Enteral nutrition remains a valuable therapeutic option in CD when applied to carefully selected patients. Although biologics and small molecules dominate current management, individualized patient selection, adherence support, and multidisciplinary education are critical to maximize its therapeutic impact.