The Crohn's Disease Exclusion Diet Across the Lifespan, Indications and the Globe: An Expert Review Towards Personalized Therapy in Crohn's Disease

Background and Aims

The Crohn's disease (CD) exclusion diet (CDED) is an established treatment for active CD with a growing body of evidence supporting its use across diverse populations and disease phenotypes. Particularly effective in mild-to-moderate cases, CDED is recognized by clinical guidelines including ESPEN, AGA and ECCO nutritional consensus.

Methods

This review collates current literature on the role of CDED across the lifespan, examining its various indications and application around the globe, while identifying evidence gaps and offering insights to enhance its integration as part of a comprehensive treatment strategy. A multidisciplinary panel including paediatric and adult gastroenterologists and registered dietitians (RD) specializing in CDED convened to review the literature and share clinical experience. The panel discussed CDED use across ages, indications, adherence strategies, cultural adaptations and the essential role of the multidisciplinary team (MDT).

Results

This review confirms that CDED is an effective induction therapy for mild-to-moderate CD, with robust evidence supporting its efficacy. The CDED might be effective across additional populations and disease phenotypes; however, due to limited evidence, definitive recommendations cannot be made, and decisions should be made collaboratively by the physician, the RD and the patient. While further research is needed to validate personalized dietary approaches, the evolution of dietary therapy marks a new era in IBD management.

Conclusions

Overall, this review highlights the potential for CDED to shift treatment paradigms by integrating nutritional therapy as an essential component of patient care throughout the lifespan and a variety of patients.

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