Gut Health Responses to Nutritional Interventions in Paediatric Crohn's Disease, Including the Potential Outcomes of Mucosal Barrier Preservation: A Systematic Review.

Background/

Objectives

Dietary treatment may play a complimentary part alongside established medical treatment pathways for children with Crohn's disease. The aim of this review was to explore the impact of a range of dietary treatments, including the capability of preserving the mucosal barrier, during the maintenance phase of Crohn's disease.

Methods

Randomised controlled trials and cohort studies were retrieved from five databases (Cochrane library, MEDLINE, EMBASE, ScienceDirect, and Web of Science) and through hand searching (last search: June 2025). In the inclusion criteria, this review only included studies that directly assessed children with Crohn's disease who achieved clinical remission after the induced phase but simultaneously appeared to have signs of inflammation.

Results

Six studies were identified, three of which reported outcomes directly associated with the mucosal barrier, while the other studies reported intestinal inflammation and nutritional status. A range of dietary approaches were investigated, with mixed outcomes. A carbohydrate-based diet had a mixed-effect influence on the mucosal barrier, whereas an exclusion diet significantly reduced intestinal inflammation (p = 0.01). One study reported that bovine colostrum (BC) milk (a novel approach) demonstrated mucosal integrity improvement, while the timing of partial enteral nutrition (PEN) also improved nutritional status. Importantly, compliance with all these strict regimes is complex and difficult to implement, even with the support of a dietitian.

Conclusions

Consideration of the most appropriate dietary approach within CD management including remission has reported mixed effects to date. Further research is needed, especially to establish the benefits and any negative consequences of dietary intervention more clearly, and especially regarding mucosal integrity.