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CD exclusion diet corrects dysbiosis

Presented by
Dr J. van Limbergen , Amsterdam University, The Netherlands
ECCO 2020
Why does dietary therapy induce remission, reduce inflammation and induce compositional changes in the microbiome in Crohn’s disease (CD)? Whole metagenome analysis revealed dietary therapy corrected dysbiosis towards healthy controls [1].

There were 2 study groups: one on the CD Exclusion Diet (CDED) and partial enteral nutrition (PEN), the other one using Exclusive Enteral Nutrition (EEN). In 178 samples from 70 participants, whole metagenome and 16S rDNA sequences were obtained at baseline, week 6, and week 12. For metagenome analysis, the groups were further divided into patients achieving intention-to-treat (ITT)-remission at week 6 (CDED+PEN: 31/38 and EEN: 23/32) and those who did not. At baseline, Proteobacteria were significantly higher in samples of active CD compared to healthy controls.

Dietary therapy decreased the relative abundance of genera from Proteobacteria towards those of healthy controls. CDED+PEN remission was associated with a significant increase in Clostridiales. Diet-induced remission (with either CDED+PEN or EEN) at week 6 was associated with a decrease in Proteobacteria: the relative abundance of Proteobacteria (e.g. Escherichia, Klebsiella, and Citrobacter) was significantly lower than at baseline, but still more outspoken in CD patients; Bacilli and Firmicutes remained more predominant in samples of healthy persons. The researchers noted that sustained dietary therapy beyond 6 weeks with CDED+PEN avoided ‘rebound’ in disease-associated species, notably Proteobacteria, when the oral diet was reintroduced. Continued CDED+PEN between week 6 and 12 was associated with a further decrease in Proteobacteria. Faecalibacterium became more abundant in CD by week 12, as did Blautia and Sutterella. Anaerostipes, Ruminococcus, Bacilli, Porphyromonadaceae, Bifidobacteriales, Ascomycota, and Caudovirales were more abundant in healthy samples than in the CDED+PEN group at week 12.

    1. Van Limbergen, et al. ECCO-IBD 2020, OP22.

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