克罗恩病排除饮食:证据,实施策略,实践指导和未来方向的综合回顾。

IF 4.5 3区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY
Rotem Sigall Boneh, Catherine Westoby, Ilan Oseran, Chen Sarbagili-Shabat, Lindsey G Albenberg, Paolo Lionetti, Víctor Manuel Navas-López, Javier Martín-de-Carpi, Henit Yanai, Nitsan Maharshak, Johan Van Limbergen, Eytan Wine
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引用次数: 0

摘要

近年来,饮食疗法在克罗恩病(CD)的治疗中得到越来越多的认可,根据现行指南,包括将肠内营养(EEN)作为儿科CD的一线治疗方法。克罗恩病排除饮食(CDED)是一种全食物饮食,旨在减少对肠道微生物群、免疫反应和肠道屏障产生负面影响的潜在促炎饮食成分的暴露。包括随机对照试验在内的累积证据表明,CDED已成为EEN的有效替代方法,支持在儿童和成人中用于诱导缓解并可能维持治疗。我们聚集了一组多学科专家,包括儿科和成人胃肠病学家,炎症性肠病(IBD)专家营养师和心理学家,讨论证据,确定差距,并在全面回顾CDED文献和专业经验的基础上提供改进CDED使用的见解。本文综述了儿童和成人CDED的管理,CDED的长期方面,适应症和禁忌症,选择最佳候选人,确定CDED的挑战,全球化,多学科团队的作用,特别是营养师的作用,以及未来的方向。我们的结论是,CDED是一种既定的饮食疗法,可以作为许多儿科和成人病例的EEN替代方案,特别是轻中度疾病。在严重疾病、复杂表型或累及肠外的情况下,根据医生和营养师的判断,CDED应逐案考虑。需要更多的研究来评估CDED在不同情况下的疗效。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The Crohn's Disease Exclusion Diet: A Comprehensive Review of Evidence, Implementation Strategies, Practical Guidance, and Future Directions.

Dietary therapy is increasingly recognized for the management of Crohn's disease (CD) over recent years, including the use of exclusive enteral nutrition (EEN) as first-line therapy for pediatric CD according to current guidelines. The Crohn's disease exclusion diet (CDED) is a whole-food diet designed to reduce exposure to dietary components that are potentially pro-inflammatory, mediated by negative effects on the gut microbiota, immune response, and the intestinal barrier. The CDED has emerged as a valid alternative to EEN with cumulative evidence, including randomized controlled trials, supporting use for induction of remission and possibly maintenance in children and adults. We gathered a group of multidisciplinary experts, including pediatric and adult gastroenterologists, inflammatory bowel diseases (IBD) expert dietitians, and a psychologist to discuss the evidence, identify gaps, and provide insights into improving the use of CDED based on a comprehensive review of CDED literature and professional experience. This article reviews the management of CDED in both children and adults, long-term aspects of CDED, indications and contraindications, selecting the best candidates, identifying challenges with CDED, globalization, the role of the multidisciplinary team, especially of dietitian, and future directions. We concluded that CDED is an established dietary therapy that could serve as an alternative to EEN in many pediatric and adult cases, especially with mild to moderate disease. In severe disease, complicated phenotypes, or with extraintestinal involvement, CDED should be considered on a case-by-case basis, according to physician and dietitians' discretion. More studies are warranted to assess the efficacy of CDED in different scenarios.

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来源期刊
Inflammatory Bowel Diseases
Inflammatory Bowel Diseases 医学-胃肠肝病学
CiteScore
9.70
自引率
6.10%
发文量
462
审稿时长
1 months
期刊介绍: Inflammatory Bowel Diseases® supports the mission of the Crohn''s & Colitis Foundation by bringing the most impactful and cutting edge clinical topics and research findings related to inflammatory bowel diseases to clinicians and researchers working in IBD and related fields. The Journal is committed to publishing on innovative topics that influence the future of clinical care, treatment, and research.
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