Harnessing the power of trillions of microscopic inhabitants to heal from within
When a child is diagnosed with Crohn's disease, families face a difficult treatment decision: powerful steroids with concerning side effects or a radical nutritional approach that completely transforms eating habits. This isn't just about food versus medicine—it's about harnessing the power of trillions of microscopic inhabitants in our gut to heal from within.
Crohn's disease is a chronic inflammatory condition of the digestive tract that disrupts the body's ability to absorb nutrients, potentially leading to malnutrition in children during critical developmental years 2 3 .
| Treatment | Mechanism | Key Benefits | Limitations |
|---|---|---|---|
| Corticosteroids (CS) | Powerful anti-inflammatory drugs that quickly reduce immune system activity | Rapid symptom control | Significant side effects, no long-term healing 1 4 |
| Exclusive Enteral Nutrition (EEN) | Complete nutritional formula while avoiding all regular foods for 6-8 weeks | Addresses nutritional deficiencies while modulating gut inflammation 1 2 | Difficult adherence due to dietary restrictions |
| Partial Enteral Nutrition (PEN) | Combines nutritional formulas with regular food intake | Easier adherence while providing therapeutic benefits 2 | Potentially less effective than EEN |
In 2023, a comprehensive systematic review and meta-analysis published in the British Journal of Nutrition analyzed three randomized controlled trials involving 76 children and sixteen cohort studies encompassing 1,104 pediatric patients with Crohn's disease 1 2 3 .
The 2018 randomized prospective clinical trial by Bénédicte Pigneur and colleagues directly compared EEN versus steroid-based induction therapy on both mucosal healing and bacterial composition 5 .
Children with confirmed active Crohn's disease were randomly assigned to treatment groups
EEN group consumed only liquid formula for 8 weeks vs. corticosteroid group receiving standard drug therapy
Clinical data, stool samples, and endoscopies collected before and after treatment
Using 16S ribosomal RNA gene sequencing to identify bacterial species 5
Standardized endoscopic examinations to objectively measure intestinal lining repair
Understanding how treatments like EEN work requires sophisticated laboratory techniques that allow scientists to identify and characterize complex microbial communities 2 .
| Research Tool | Primary Function | Application in EEN Research |
|---|---|---|
| 16S rRNA Gene Sequencing | Identifies and classifies bacterial species | Profiling gut microbiome changes before and after EEN |
| Shannon Diversity Index | Measures microbial diversity | Comparing biodiversity in EEN vs. steroid patients 1 2 |
| Bray-Curtis Index | Quantifies similarity between microbial communities | Tracking how EEN shifts microbiome composition |
| Faecal Calprotectin (FC) | Measures intestinal inflammation | Objectively assessing disease activity and treatment response |
| Simple Endoscopic Score (SES-CD) | Standardizes assessment of mucosal healing | Quantifying endoscopic improvement with EEN |
| Pediatric Crohn's Disease Activity Index (PCDAI) | Evaluates clinical disease activity | Measuring symptomatic response to EEN |
This method targets a specific gene that's present in all bacteria but contains variable regions that are unique to different species—essentially providing a "genetic barcode" for identification 2 .
The growing evidence favoring EEN over corticosteroids has significant practical implications. The superior mucosal healing and reduced adverse events suggest EEN should be considered as a first-line treatment 1 2 .
Higher rates of mucosal healing with EEN compared to steroids
Addresses nutritional deficiencies while treating inflammation
Recent studies suggest that allowing some regular food alongside nutritional formulas may improve adherence while still providing significant therapeutic benefits. Some research indicates PEN can be as effective as EEN in inducing clinical and endoscopic remission while being better tolerated by pediatric patients 2 .
The evidence is now compelling: exclusive enteral nutrition isn't just an alternative to corticosteroids—it's a superior first-line treatment for many children with active Crohn's disease.
By achieving better mucosal healing with fewer adverse events, EEN addresses the root cause of the disease rather than merely suppressing symptoms. The fascinating discovery that its effectiveness may stem from reshaping the gut microbiome opens exciting new avenues for understanding and treating not just Crohn's disease, but potentially other inflammatory conditions linked to microbial dysbiosis 1 2 5 .
The future of Crohn's disease treatment may not lie in more powerful drugs, but in learning to better nourish the trillions of microbial partners that call our gut home.