Complement Ther Med. 2020 Aug;52:102493. doi: 10.1016/j.ctim.2020.102493.Epub 2020 Jun 26.

M Schwermer ¹, K Fetz ², A Längler ³, T Ostermann ⁴, T J Zuzak ⁵

Author information

• ¹Department of Pediatrics, Gemeinschaftskrankenhaus Herdecke, Germany, Professorship for Integrative Pediatrics, Institute for Integrative Medicine, Witten/Herdecke University, Germany. Electronic address: m.schwermer@gemeinschaftskrankenhaus.de.
• ²Department of Psychology, Chair of Research Methodology and Statistics in Psychology, Witten/Herdecke University, Germany. Electronic address: katharina.fetz@uni-wh.de.
• ³Department of Pediatrics, Gemeinschaftskrankenhaus Herdecke, Germany, Professorship for Integrative Pediatrics, Institute for Integrative Medicine, Witten/Herdecke University, Germany. Electronic address: a.laengler@gemeinschaftskrankenhaus.de.
• ⁴Department of Psychology, Chair of Research Methodology and Statistics in Psychology, Witten/Herdecke University, Germany. Electronic address: Thomas.ostermann@uni-wh.de.
• ⁵Department of Pediatrics, Gemeinschaftskrankenhaus Herdecke, Germany, Faculty of Medicine, University of Duisburg-Essen, Germany. Electronic address: t.zuzak@gemeinschaftskrankenhaus.de.

Abstract

Children with diagnosed inflammatory bowel diseases such as Crohn's disease are faced with the daunting prospect of living with a chronic disease. Besides psychological stress, children are suffering from therapy side-effects; in particular, corticosteroid therapies are problematic in the growth phase. This highlights that there is a need for less aggressive alternative therapies for children as well as adolescents living with such chronic conditions. Elemental diets are widely used and accepted therapy options. Several pediatric Crohn's disease patients also use complementary, alternative and integrative therapies to reduce or avoid drug therapies. To survey such therapy options and their efficiency and safety, we performed a systematic literature search and screened databases (Cochrane Library, EMBASE, OvidSP, PubMed, CAMbase, CAM-QUEST, Anthromedics) from their inception to December 2019. In total, seven of 1439 studies fulfilled search criteria. Six RCTs and one retrospective controlled trial investigating elemental diets (Flexical, Elemental 028), semi-elemental diets (Pregomin), polymeric diets (Modulen IBD), whole protein based formulas, and ω-3 fatty acid supplementation were found. Data indicated that diet therapies were equal to or more effective than corticosteroid therapies when used to treat Crohn's disease. Regrettably, we could not identify controlled studies investigating complementary, alternative and integrative medicine approaches. Our review provides an updated overview of controlled studies investigating dietary therapies used in the treatment of pediatric Crohn's disease, and demonstrates that the current study situation does not reflect the actual use of complementary, alternative and integrative therapies. Therefore, clinical trials are necessary to estimate risks and benefits of such therapies. The review indicated that enteral diets and ω-3 fatty acid supplementation may be an effective alternative to corticosteroid treatments for children with Chron's disease.