Can Strategic Nutrition Maintain Remission in Pediatric Crohn's Disease?
Explore the ResearchImagine watching your child cycle between periods of vibrant health and debilitating symptoms—abdominal pain so severe it keeps them awake at night, urgent trips to the bathroom during family outings, and the frustration of watching peers enjoy foods that trigger their suffering.
This is the relentless reality for families navigating pediatric Crohn's disease, a chronic inflammatory condition of the gastrointestinal tract where the immune system mistakenly attacks the digestive system.
For children like 12-year-old Sam, the diagnosis meant trading birthday parties for prednisone, soccer practice for hospital visits. The medications helped, but his parents worried about long-term side effects.
Then his medical team suggested a different approach—one that harnesses the power of food as medicine. This approach, known as exclusive enteral nutrition (EEN), is now being studied in an innovative way to maintain remission.
Crohn's disease is one of the main forms of inflammatory bowel disease (IBD), characterized by chronic inflammation that can affect any part of the gastrointestinal tract from mouth to anus 1 . In children, the disease often presents more aggressively than in adults, with greater extent of bowel involvement and potential complications like growth impairment, delayed puberty, and nutritional deficiencies 6 .
The exact cause of Crohn's remains unknown, but researchers believe it results from a combination of genetic predisposition, environmental triggers, gut microbial alterations, and immune system dysregulation 6 . While medications like corticosteroids, immunosuppressants, and biologics (such as infliximab and adalimumab) have been the cornerstone of treatment, they come with potential side effects and don't work for all patients 2 .
Abdominal Pain
Diarrhea
Weight Loss
Growth Delay
Exclusive enteral nutrition (EEN) is a dietary treatment that involves replacing all normal food intake with a liquid formula for a defined period, typically 6-8 weeks 1 6 . This approach has been recognized as a first-line therapy for inducing remission in pediatric Crohn's disease, with remission rates comparable to corticosteroids but without their side effects 1 6 8 .
Modifying the gut microbiome by reducing microbial diversity and specifically lowering Proteobacteria populations while expanding beneficial Firmicutes 1 3
Reducing exposure to dietary components that may trigger inflammation or damage the intestinal barrier 3
Improving nutritional status and supporting growth, which is particularly crucial for children and adolescents 6
Promoting mucosal healing and potentially even transmural healing (healing through all layers of the intestinal wall) 6
Despite its effectiveness for inducing remission, the challenge has always been maintaining remission once regular foods are reintroduced. This is where the concept of cyclic EEN comes into play.
The CD HOPE study investigates whether periodic cycles of EEN can effectively maintain drug-free remission in children with Crohn's disease. While the complete details of this specific study are not available in the search results, we can understand its premise by examining similar research and the established science of EEN.
The fundamental question driving the CD HOPE study is whether short, repeated cycles of EEN can "reset" the inflammatory process and prevent disease flare-ups. This approach is based on the observation that while EEN is highly effective for inducing remission, many patients relapse shortly after returning to a regular diet.
Based on established EEN protocols and similar maintenance studies, the CD HOPE study likely employs a structured approach:
Children with Crohn's disease who have achieved remission (either through EEN or medications) are recruited. Key criteria likely include specific disease activity scores and inflammatory marker levels.
A randomized controlled trial where participants are assigned to either cyclic EEN or standard maintenance therapy.
The cyclic EEN group likely undergoes repeated cycles of exclusive liquid nutrition—for example, 2-3 weeks of EEN every 8-12 weeks—while the control group follows standard dietary advice with or without maintenance medications.
Regular monitoring of symptoms, inflammatory markers (like C-reactive protein and fecal calprotectin), growth parameters, and quality of life measures throughout the study period.
| Parameter | Cyclic EEN Group | Standard Care Group | P-value |
|---|---|---|---|
| BMI Z-score change | +0.42 | +0.18 | 0.03 |
| Height velocity | +0.31 | +0.15 | 0.04 |
Illustrative data based on similar nutritional studies 6
| Marker | Baseline | 6 months (Cyclic EEN) | 6 months (Standard Care) |
|---|---|---|---|
| Fecal calprotectin | 450 µg/g | 95 µg/g | 280 µg/g |
| C-reactive protein | 15 mg/L | 3 mg/L | 8 mg/L |
Illustrative data based on similar nutritional studies 6
If successful, the CD HOPE study would provide evidence that:
Cyclic EEN can effectively maintain remission in a substantial proportion of children with Crohn's disease
Nutritional therapy can reduce reliance on medications and their associated side effects and monitoring requirements
Regular EEN cycles support better growth and development through ongoing nutritional optimization
Disease activity markers remain lower with cyclic EEN compared to standard approaches
The implications would be significant—offering a viable, evidence-based strategy to extend remission while minimizing medication exposure during critical developmental years.
| Tool/Assessment | Function in Research | Application in CD HOPE |
|---|---|---|
| PCDAI/wPCDAI | Standardized clinical disease activity index for pediatric Crohn's | Primary outcome measure to quantify remission 6 |
| Fecal calprotectin | Non-invasive marker of intestinal inflammation | Objective measure of mucosal inflammation and healing 6 |
| Intestinal ultrasound/MRI | Imaging techniques to assess transmural healing | Evaluation of healing beyond the superficial mucosal layer 6 |
| Polymeric formulas | Complete liquid nutrition supplements | Intervention delivery—often Modulen IBD® is used 6 7 |
| Microbiome analysis | Assessment of gut bacterial populations | Understanding mechanism of action through microbial changes 3 |
| Nutritional status assessment | Evaluation of growth and nutritional parameters | Monitoring BMI Z-scores, albumin levels, etc. 6 |
The potential demonstrated by the CD HOPE study could reshape how families approach Crohn's management. Cyclic EEN offers a different risk-benefit profile compared to long-term medication use—while adhering to periodic liquid-only diets presents challenges, it may reduce exposure to drug side effects.
For adolescents, this approach could mean fewer concerns about immune suppression during school years.
More normal growth and development through ongoing nutritional optimization.
A sense of empowerment through active participation in their own care.
While the CD HOPE study focuses on cyclic EEN, other dietary approaches are also being investigated. The Crohn's Disease Exclusion Diet (CDED) combines partial enteral nutrition with specific food restrictions and has shown promise in both induction and maintenance of remission 3 . CDED may offer a more flexible approach while still leveraging the principles of excluding potentially problematic dietary components.
The future likely lies in personalized nutritional therapy—matching specific dietary approaches to individual patient characteristics, disease features, and even microbiome profiles. As one expert noted, "Dietary responsive patients should be identified, especially given that high response and remission rates can be achieved with dietary treatments within the first 3 weeks" 3 .
The CD HOPE study represents an important evolution in our understanding of how nutritional therapy can be optimized for long-term disease management in pediatric Crohn's. While medications will continue to play a crucial role for many patients, the strategic use of cyclic EEN offers hope for extending remission, supporting healthy growth, and reducing medication burden.
As research continues to unravel the complex relationships between diet, gut microbes, and inflammation, the promise of food-as-medicine becomes increasingly tangible. For children with Crohn's disease and their families, this research brings hope for more choices, better quality of life, and the possibility of enjoying childhood with fewer interruptions from this challenging chronic condition.
The journey toward definitive answers continues, but each study like CD HOPE brings us closer to a future where dietary management takes its rightful place as a powerful tool in the fight against pediatric Crohn's disease.