Przeglad gastroenterologiczny · 2026
Remission duration according to dietary adherence in paediatric mild to moderate Crohn's disease treated with CDED + PEN.
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Wiernicka Anna, Jałocha Izabela, Garwolińska Małgorzata
Аннотация
INTRODUCTION: The Crohn's Disease Exclusion Diet (CDED) combined with partial enteral nutrition (PEN) is a dietary therapy developed to induce and maintain remission in patients with Crohn's disease.
AIM: The aim of study was to evaluate the duration of clinical remission in paediatric patients with mild to moderate Crohn's disease undergoing a Crohn's Disease Exclusion Diet (CDED) combined with partial enteral nutrition (PEN), stratified by degree of dietary adherence.
MATERIAL AND METHODS: A retrospective, single-centre observational study was conducted with the participation of paediatric patients who underwent CDED + PEN treatment in the period from June 2019 to June 2025. Twelve-month clinical follow-up was available in 41 subjects. The following were assessed: BMI-SDS index (group 6-17 years), erythrocyte sedimentation rate, C-reactive protein, faecal calprotectin, Pediatric Crohn's Disease Activity Index (PCDAI) scale score, and adherence. Time to relapse was analysed.
RESULTS: Data from 54 patients aged 6-17 years were analysed. Mean baseline PCDAI was 15.47 ±12.44. Clinical remission (PCDAI < 10) was achieved in 69% at week 6 and in 77% at week 12. The median time to relapse was 8.2 months. A statistically significant factor influencing the duration of remission was identified. The median remission time was 11.97 months (IQR: 7.60-25.98; mean: 18.75 ±16.18) in patients with adherence ≥ 80% (n = 17) and 5.63 months (IQR: 4.97-8.03; mean: 6.88 ±4.02) with adherence < 80% (n = 10). The mean difference between groups was 11.9 months (95% CI: 3.3-20.5); Welch's test p = 0.009. An F-test confirmed unequal variances (p = 0.0002).
CONCLUSIONS: Suboptimal adherence remains a key modifiable predictor of relapse. Data support consideration of CDED + PEN as a viable long-term strategy in motivated families and underscore the pivotal role of the dietitian in monitoring adherence and nutritional status.
AIM: The aim of study was to evaluate the duration of clinical remission in paediatric patients with mild to moderate Crohn's disease undergoing a Crohn's Disease Exclusion Diet (CDED) combined with partial enteral nutrition (PEN), stratified by degree of dietary adherence.
MATERIAL AND METHODS: A retrospective, single-centre observational study was conducted with the participation of paediatric patients who underwent CDED + PEN treatment in the period from June 2019 to June 2025. Twelve-month clinical follow-up was available in 41 subjects. The following were assessed: BMI-SDS index (group 6-17 years), erythrocyte sedimentation rate, C-reactive protein, faecal calprotectin, Pediatric Crohn's Disease Activity Index (PCDAI) scale score, and adherence. Time to relapse was analysed.
RESULTS: Data from 54 patients aged 6-17 years were analysed. Mean baseline PCDAI was 15.47 ±12.44. Clinical remission (PCDAI < 10) was achieved in 69% at week 6 and in 77% at week 12. The median time to relapse was 8.2 months. A statistically significant factor influencing the duration of remission was identified. The median remission time was 11.97 months (IQR: 7.60-25.98; mean: 18.75 ±16.18) in patients with adherence ≥ 80% (n = 17) and 5.63 months (IQR: 4.97-8.03; mean: 6.88 ±4.02) with adherence < 80% (n = 10). The mean difference between groups was 11.9 months (95% CI: 3.3-20.5); Welch's test p = 0.009. An F-test confirmed unequal variances (p = 0.0002).
CONCLUSIONS: Suboptimal adherence remains a key modifiable predictor of relapse. Data support consideration of CDED + PEN as a viable long-term strategy in motivated families and underscore the pivotal role of the dietitian in monitoring adherence and nutritional status.