Dietary triggers of gut inflammation following exclusive enteral nutrition in children with Crohn's disease: a pilot study

Konstantinos Gkikas, Michael Logan, Ben Nichols, Umer Z. Ijaz, Clare M. Clark, Vaios Svolos, Lisa Gervais, Hazel Duncan, Vikki Garrick, Lee Curtis, Elaine Buchanan, Tracey Cardigan, Lawrence Armstrong, Caroline Delahunty, Diana M. Flynn, Andrew R. Barclay, Rachel Tayler, Simon Milling, Richard Hansen, Richard K. RussellKonstantinos Gerasimidis

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Background: The anti-inflammatory effect of exclusive enteral nutrition on the gut of children with Crohn’s disease is rapidly lost after food reintroduction. This study assessed disease dietary triggers following successful treatment with exclusive enteral nutrition.

Methods: Nutrient intake, dietary patterns and dietary biomarkers in faeces (gluten immunogenic peptides, undigestible starch, short chain fatty acids) were assessed in 14 children with Crohn’s disease during early food reintroduction, following exclusive enteral nutrition. Groups above (Group A) and below (Group B) the median levels of faecal calprotectin after food reintroduction were assigned for comparative analysis.

Results: Intakes of fibre, gluten-containing cereals and red and processed meat were significantly higher in Group A than Group B; (median [Q1, Q3], g/day; Fibre: 12.1 [11.2, 19.9] vs. 9.9 [7.6, 12.1], p = 0.03; Red and processed meat: 151 [66.7, 190] vs. 63.3 [21.7, 67], p = 0.02; gluten-containing cereals: 289 [207, 402] vs. 203 [61, 232], p = 0.035). A diet consisting of cereals and meat products was predictive (92% accuracy) of higher faecal calprotectin levels after food reintroduction. In faeces, butyrate levels, expressed as absolute concentration and relative abundance, were higher in Group A than Group B by 28.4 µmol/g (p = 0.015) and 6.4% (p = 0.008), respectively. Levels of gluten immunogenic peptide and starch in faeces did not differ between the two groups.

Conclusions: This pilot study identified potential dietary triggers of gut inflammation in children with Crohn’s disease after food reintroduction following treatment with exclusive enteral nutrition.
Original languageEnglish
Article number454
Number of pages11
JournalBMC Gastroenterology
Publication statusPublished - 3 Dec 2021


  • Crohn’s disease
  • Food reintroduction
  • Dietary triggers
  • Faecal calprotectin
  • Gluten
  • Fibre
  • Meat
  • Short chain fatty acids


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