背景:在克罗恩病(CD)的诱导缓解中,诸如专有肠内营养(EEN)等高度限制性饮食疗法的功效已得到证实,然而,存在持续的问题,其适口性差,限制,和坚持。这篇综述的主要目的是评估目前的证据,证明完全固体食物饮食对诱导和维持CD临床和生化缓解的有效性。次要目标包括对内窥镜愈合和生活质量的影响。
方法:对所有随机对照试验(RCT)的系统评价,对活动性或非活动性克罗恩病患者进行了评估固体食物饮食干预的开放标签随机试验和头对头临床试验.研究包括在基线和随访时具有经过验证的疾病活动指数的成人和儿科患者(HarveyBradshaw指数,HBI;克罗恩病活动指数,CDAI和儿科CDAI,PCDAI)。其他次要终点在研究之间有所不同,包括内窥镜和生化反应,以及生活质量指标。两位作者独立对研究进行了批判性评估,包括研究选择和偏见风险评估。
结果:14项研究纳入综述,几项研究表明有临床意义的发现。在接受地中海饮食(MD)(中度偏倚风险)的儿科人群中实现了临床缓解。在成年人中,在诱导缓解(中度偏倚风险)方面,克罗恩病排除饮食(CDED)与部分肠内营养(PEN)饮食的CDED相当.低发酵低聚糖,二糖,单糖和多元醇(FODMAP)饮食也被证明可以减少静态或轻度活跃CD(高偏倚风险)患者的症状,然而,这没有得到其他低FODMAP饮食研究的证实.
结论:MD和CDED在诱导轻度至中度CD的临床缓解方面具有良好的结果。由于设计限制,需要谨慎解释结果,包括合并CD和UC患者结局的问题,样本量小。目前在CD中进行固体食物饮食治疗的证据受到缺乏高质量研究和中等偏倚的限制。未来需要精心设计的研究来证实其疗效。
BACKGROUND: The efficacy of highly restrictive dietary therapies such as exclusive enteral nutrition (EEN) in the
induction of remission in Crohn\'s disease (CD) are well established, however, ongoing issues exist with its poor palatability, restrictions, and adherence. The primary aim of this review is to evaluate the current evidence for the efficacy of exclusively solid food diets on the
induction and maintenance of clinical and biochemical remission in CD. Secondary aims include impact on endoscopic healing and quality of life.
METHODS: A systematic review of all randomised controlled trials (RCTs), open-label randomised trials and head-to-head clinical trials assessing solid food diet intervention in patients with active or inactive Crohn\'s disease was conducted. Studies included adult and paediatric patients with a verified disease activity index at baseline and follow up (Harvey Bradshaw Index, HBI; Crohn\'s disease activity index, CDAI and paediatric CDAI, PCDAI). Additional secondary endpoints varied between studies, including endoscopic and biochemical responses, as well as quality of life measures. Two authors independently performed critical appraisals of the studies, including study selection and risk of bias assessments.
RESULTS: 14 studies were included for review, with several studies suggesting clinically significant findings. Clinical remission was achieved in a paediatric population undertaking the Mediterranean diet (MD) (moderate risk of bias). In adults, the Crohn\'s disease exclusion diet (CDED) was comparable to the CDED with partial enteral nutrition (PEN) diet in
induction of remission (moderate risk of bias). A low fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) diet was also shown to decrease symptoms in patients with quiescent or mildly active CD (high risk of bias), however, this was not corroborated by other low FODMAP diet studies.
CONCLUSIONS: There are promising outcomes for the MD and CDED in inducing clinical remission in mild to moderate CD. The results need to be interpreted with caution due to design limitations, including issues with combining outcomes among CD and UC patients, and small sample size. The current evidence for solid food dietary therapy in CD is limited by the lack of high quality studies and moderate to high bias. Future well designed studies are needed to confirm their efficacy.