ORIGINAL ARTICLE Ingested Matter Affects Intestinal Lesions in Crohn’s Disease

Background: Environmental factors of the modern Western life-style may trigger Crohn’s disease (CD) in susceptible individuals. Because such factors could be part of ingested matter, we intended to improve intestinal Crohn’s lesions by exclusion thereof. Methods: At first we tested a highly restricted diet (based on spelt bread and red meat, both derived from intensively monitored organic farming) in 5 pilot cases. In a subsequent controlled trial, 18 patients with mild-to-moderate CD were randomly assigned to receive either this active diet or a control diet (low-fiber, low-fat, and high-carbohydrate). Mucosal improvement was assessed by magnetic resonance imaging (MRI) and endoscopy. Secondary endpoints in-cluded sonography, the Crohn’s Disease Activity Index (CDAI), and the Inflammatory Bowel Disease Questionnaire (IBDQ). Results: Four of 5 pilot patients showed significant improvement within 4 weeks. From 18 patients in the controlled trial, 8 were randomized to the active and 10 to the control group; 4 decided to quit immediately after dietary counseling, 3 in the active and 1 in the control group (P 0.183). At 6 weeks MRI and endoscopy showed improvement of intestinal lesions in 3 of 4 assessable patients of the active group and 1 of 9 patients of the control group (P 0.027). Sonography showed improvement in 4 of 5 patients of the activ