Hypothesis summary
A liquid-only diet (without any of a patient’s normal food or drink) for 8 weeks, called Exclusive Enteral Nutrition (EEN), is the best initial treatment for cases with active Crohn’s Disease (CD). Dr Gerasimidis has shown previously that this liquid-only diet works by changing the bacteria (germs) in the gut. This liquid-only diet is however very restrictive, and patients can find it difficult to stick to it for a long time, particularly if they are adults. Therefore, there is a lot of interest and enthusiasm from patients and their clinical teams to develop new diets that work as well as the liquid-only diet, but do not involve stopping all solid food. Such a solid food diet is more acceptable to most patients than a liquid-only diet.
In a questionnaire survey conducted by the BINGO group, 70% of the patients said they would prefer a solid food over a liquid-only diet. They also indicated they would be willing to participate in studies testing such diets.
Dr Gerasimidis and the BINGO group have recently developed a solid food diet using everyday foods (called CD-TREAT), which they hope will work as well as the liquid-only diet. They have shown previously that CD-TREAT changes the gut bacteria of healthy people in a similar way to the liquid-only diet. The solid diet also improved gut inflammation in animal experiments.
Currently CD-TREAT is used as part of an open-label trial in CD patients with active disease, instead of using their standard medical treatment.
The BINGO group is planning to recruit 10 adults and 10 children with CD who need treatment. They will provide patients with the CD-TREAT diet, as their only dietary source, for a maximum of 12 weeks. CD-TREAT meals will be prepared and provided to the patients free, using a food catering company. During treatment with CD-TREAT, researchers will collect three to four blood and stool samples.
These samples will be used to measure changes in disease markers and gut bacteria. The researches will also monitor body weight changes, how easy patients can stick to CD-TREAT, and how they cope with daily activities and changes to their lifestyle. These tests will be repeated before the start, during, and at the end of the treatment with the CD-TREAT diet. The researchers will also compare the cost of CD-TREAT against the liquid-only diet.
The BINGO group is optimistic that CD-TREAT will work. In this case, doctors, nurses and dietitians will be able to decrease or replace harmful drugs and potentially avoid surgery in some patients.