What is already known
Crohn’s disease is a long-term inflammatory condition of the gastrointestinal tract that is increasingly affecting children in Western countries, with causes linked to genetic and environmental factors such as diet and gut bacteria. Exclusive enteral nutrition (EEN), a specialized fiber-free liquid diet, is the primary treatment for Crohn’s disease in children. EEN has been shown to modify gut bacteria, but many patients experience a return of symptoms once they resume normal eating.
What this research adds
By analyzing the gut microbiota and metabolites of 20 children with Crohn’s disease, researchers found that EEN helps induce remission by changing the gut microbiota, even though there are variations in individual children’s microbiotas. EEN boosted the activity of certain beneficial bacteria, including those responsive to medium-chain fatty acids, a type of saturated fat that provides a quick source of energy to the body. Stopping EEN caused changes in gut bacteria in children with Crohn’s disease patients, leading to the return of symptoms.
Conclusions
The findings highlight the importance of maintaining a healthy microbiota after EEN and suggest that personalized dietary approaches can help induce remission for children with Crohn’s disease.
Crohn’s disease is a long-term inflammatory condition of the gastrointestinal tract that is increasingly affecting children in Western countries, with causes linked to genetic and environmental factors such as diet and gut bacteria. New research now shows that exclusive enteral nutrition (EEN), a specialized fiber-free liquid diet that is commonly used to treat the condition in children, helps ease symptoms by changing the gut microbiota.
The findings, published in Cell Host & Microbe, highlight the importance of maintaining a healthy microbiota after EEN and suggest that personalized dietary approaches can helps induce remission for children with Crohn’s disease.
Previous studies have shown that EEN can protect gut health by targeting certain bacteria, leading to potential therapeutic benefits. However, many patients experience a return of symptoms once they resume normal eating.
To examine how gut bacteria change in response to EEN, Deborah Haecker at Technische Universitaet Muenchen in Germany and her colleagues analyzed the microbiota and metabolites of 20 children with Crohn’s disease receiving EEN.
Helping remission
The researchers found that EEN eased disease symptoms in all children, leading to remission in most of them, although some experienced a relapse within a year.
Children on EEN had different gut bacteria and metabolites compared to those on regular diets. In the EEN formula, the researchers identified three medium-chain fatty acids that activated specific gut microbes. Medium-chain fatty acids are a type of saturated fat that provides a quick source of energy to the body.
EEN also increased the activity of Enterocloster bacteria, which may have beneficial effects on Crohn’s disease. Stopping EEN caused changes in gut bacteria in children with the condition, leading to the return of symptoms, the researchers found.
Personalized treatments
Next, the team transferred fecal samples from children with Crohn’s disease to mice and found that EEN reduced inflammation in the animals, while returning to a regular diet increased inflammation. These results suggest that EEN has protective effects on gut bacteria that may decrease over time, the researchers say.
The analysis also indicated that EEN induces unique changes in individual microbiotas, influencing which strains are present. Each child showed a distinct microbial profile that responded differently to treatment, highligting the need for tailored treatments.
“Our data clearly demonstrate that EEN therapy mediates protective changes in individually variant microbiome profiles, leading toward personalized patient-to-patient species and strain signatures,” the authors say. “These findings support the idea of developing patient-tailored maintenance strategies in pediatric [Crohn’s disease] involving combinations of personalized nutritional and bacterial interventions.”
