Exclusive enteral nutrition versus the Crohn's disease exclusion diet for remission induction in pediatric Crohn's disease: 52‐week study

OBJECTIVE: Nutritional therapy is a cornerstone for the induction of remission in pediatric Crohn's disease (CD); however, the optimal dietary strategy remains uncertain. This study aimed to compare the short- and long-term therapeutic outcomes of exclusive enteral nutrition (EEN) and the Crohn's disease exclusion diet (CDED) in a large cohort of children with CD. METHODS: This historical cohort study included children diagnosed with CD between 2014 and 2023 who were treated exclusively with either EEN or the CDED for the induction of disease remission. Demographic, clinical, and laboratory data were collected over a 52-week follow-up period. RESULTS: A total of 159 patients were included: 75 treated with EEN and 84 with the CDED. Baseline demographic and disease characteristics were comparable between groups. At 6 weeks, clinical remission was achieved in 58 (77%) children in the EEN group and 63 (75%) children in the CDED group (p = 0.730). Treatment adherence rates were similarly high (EEN 89% vs. CDED 88%, p = 0.810). Week 6 normalization of C-reactive protein (EEN 43% vs. CDED 46%, p = 0.709) and fecal calprotectin <150 mcg/g (EEN 35% vs. CDED 34%, p = 0.982) were also comparable between the groups. A Mucosal Inflammation Noninvasive index score <8 was documented in 52% versus 69% of the groups, respectively (p = 0.219). There were no group differences in rates of disease exacerbation, corticosteroid or biologic therapy use, hospitalizations, or need for surgery during 52 weeks of follow-up. CONCLUSIONS: EEN and the CDED demonstrated no significant differences in efficacy across all assessed clinical and biochemical outcomes throughout the 52-week follow-up period.