BMC Gastroenterol. 2021 Dec 3;21(1):454.doi: 10.1186/s12876-021-02029-4.

Konstantinos Gkikas ¹, Michael Logan ¹, Ben Nichols ¹, Umer Z Ijaz ², Clare M Clark ¹, Vaios Svolos ¹, Lisa Gervais ³, Hazel Duncan ⁴, Vikki Garrick ³, Lee Curtis ³, Elaine Buchanan ³, Tracey Cardigan ³, Lawrence Armstrong ⁴, Caroline Delahunty ⁵, Diana M Flynn ³, Andrew R Barclay ³, Rachel Tayler ³, Simon Milling ⁶, Richard Hansen ³, Richard K Russell ⁷, Konstantinos Gerasimidis ⁸

Author information

¹Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.

²Civil Engineering, School of Engineering, University of Glasgow, Glasgow, UK.

³Department of Paediatric Gastroenterology, Hepatology and Nutrition, Royal Hospital for Children, Glasgow, UK.

⁴Department of Paediatrics, Crosshouse Hospital, Kilmarnock, UK.

⁵Department of Paediatrics, Wishaw General Hospital, Wishaw, UK.

⁶Institute for Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK.

⁷Royal Hospital for Children and Young People, Edinburgh, UK.

⁸Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK. konstantinos.gerasimidis@glasgow.ac.uk.

Abstract

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.

Trial registration: Clinical trials.gov registration number: NCT02341248; Clinical trials.gov URL: https://clinicaltrials.gov/ct2/show/NCT02341248 (retrospectively registered).