P167 ADULT CROHN’S DISEASE TREATED WITH THE SPECIFIC CARBOHYDRATE DIET (SCD): A CASE REPORT USING OBJECTIVE MARKERS OF RESPONSE

• Published in: Inflammatory bowel diseases Vol. 26; no. Supplement_1; p. S39
• Main Author: Arjomand, Ali
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 23.01.2020
• ISSN: 1078-0998; 1536-4844
• DOI: 10.1093/ibd/zaa010.099

Abstract The specific carbohydrate diet (SCD) has been shown to resolve symptoms in pediatric IBD patients, inducing clinical remission and normalizing or significantly reducing inflammatory markers. Demonstration of similar effects, including changes to objective disease markers, are lacking in the adult IBD patient. Presented here are clinical, biomarker, microbiome, imaging and histologic observations after successful implementation of the SCD in an adult with moderate-to-severe Crohn’s disease. HISTORY: A 50-year-old male patient, diagnosed with Crohn’s disease in 2001, implemented the SCD in 2017 according to the published protocol. Prior to diet intervention, medical management consisted of mesalamine (1 g orally 4x/day for 6 mo.); infliximab (300 mg IV/8 wks for 5 yrs), natalizumab (300 mg IV/4 wks for 6 mo.), adalimumab (40 mg sc/14 d for 7 yrs; every 7 d for 1 yr) and vedolizumab (300 mg IV/8 wks for 1 yr). Corticosteroids were administered with adalimumab and vedolizumab over a continuous span of 8 yrs (prednisone 15–20 mg/d or budesonide 9 mg/d). Two resections of the terminal ileum were performed in 2003 and 2015. History included annual ER or hospital admissions and severe malnutrition (albumin 1 g/dL). TPN was provided in 2008 and 2015. DIETARY INTERVENTION: The patient was advised to switch to ustekinumab after LOR to vedolizumab and return of active inflammation. The patient refused further biologic treatment and proceeded with the SCD intervention. Prednisone (40 mg/d) was initiated during diet transition. The patient adhered to a strict SCD protocol, eliminating sugar, grains, starch and all forms of processed foods while adding home-fermented yogurt. Results: By day 10, the patient reported loss of abdominal and lower back pain along with a 5 lb weight drop. Cooked, non-starchy vegetables, nut flours and other foods were then introduced according to the SCD protocol and as tolerated. At month 3, the patient reported 1–2 formed BM/d, increased energy and mobility, loss of joint pain and a stable weight. The patient initiated yoga 3x/wk. Advanced SCD foods continued to be introduced one at a time. Stool was well-formed and of large mass. Prednisone was tapered to 20 mg/d at month 3 and 0 mg/d by month 8. At month 12, MRE and colonoscopy showed resolution of inflammation and normal mucus in the terminal ileum assessed by biopsy. At month 24, FCP and CRP remained in the normal range. Microbiome analysis of fecal samples showed poor diversity at all times with minor phyla-level changes at month 12. International travel resulted in genus-level increase in diversity. The patient has completed 3 years with the SCD and plans to maintain the diet as part of a lifestyle change. Prospective studies are needed in adult IBD patients, including moderate-to-severe cases, to assess the long-term efficacy of the SCD using objective markers of response.