Dietary Intervention Case Study

I came across this very interesting case study and wanted to share it with all.

Parenteral nutrition (intravenous feeding) and enteral nutrition (tube feeding) with an elemental diet have been proven to control CD activity. This treatment is not widely used because it is expensive and has side effects. However, in this particular case study total disease remission was induced with non-elemental formula diet of known composition (Ensure Plus).

A 35-year-old patient was diagnosed with CD at the age of 20 (1974) after a year of diarrhea, cramps, and weight loss. He was anemic and his x-ray revealed a diformed & narrowed ileum . He was treated with sulfasalazine and prednisone (20mg/day) from 1974-1980. When he attempted to discontinue the corticosteroid he had reocurrence of cramps and anemia. From 1980-1982 his disease became more progressively active; prednisone (10-40 mg/day) was required to control his symptoms which at that time included an aphthous ulceration in the mouth and tongue. In June 1982 he had a sudden onset of gross hematochezia in the RLQ (here is a site to view images of hematochezia: http://images.google.com/images?um=1&hl=en&q=hematochezia&btnG=Search+Images). At this time prednisone was increased from 10 to 16 mg/day. An examination revealed a fistula from the ileum to the sigmoid colon with two areas of ileal stenosis; he later underwent surgery. The patient did well for about a year but later had gradual reocurrence of cramps, diarrhea, and weight loss. He was placed on prednisone again (10-30mg) for about 3-years. Everytime he attempted to reduce the prednisone dose, cramps would increase. So to make this short, his condition worsen, he had a recurrence in CD; prednisone dose was again increase to 60mg/day.
After two weeks, prednisone dosage was reduced to 40mg/day and they began a diet of solely Ensure (only caloric intake). For 10-weeks the patient only consumed Ensure and water and by the week-8, the prednisone was tapered out and discontinued for the first time in 3-years. The patient became asymptomatic. They gradually started to introduce food (chicken, beef, grean beans, etc) to the Ensure Plus Diet. He did well until he was introduced with milk, he had severe cramping and diarrhea for a week.
The patient was instructed to take Ensure Plus eat the foods he previously tolerated. His symptoms improved within a week without prednisone. The patient has remained in total remission.
I thought the case report was intriguing because they were able to induce total remission with a form of palatable enteral therapy (with Ensure Plus) in a patient with history of long-standing CD with steroid dependency. The authors claim this is the only case reported of total remission; however, they did cite another case similar to the one discussed here where milk was the food that triggered CD symptoms.

Case Report side: http://www.springerlink.com/content/v757h63674365281/fulltext.pdf
Note: I could not open this site at home, only at the UA.