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Crohn’s Disease Remission with a Plant-Based Diet: A Case Report

Plant-based dietary therapies may have utility in both the treatment of acute CD flares and the maintenance of remission.

In November 2014, a 25-year-old-male presented to the Department of Gastroenterology at a secondary care facility after having experienced several months of weight loss, diarrhea, and flu-like symptoms. He had a past medical history of peri-anal abscess and was on no prescribed or over-the-counter medications. He was a non-smoker. Ileo-colonoscopy demonstrated moderately inflamed mucosa with nodular congestion, marked erythema, and multiple shallow ulcers in the terminal ileum with minimal colonic involvement (Figure 1). The ileocecal valve appeared normal. A few small, non-bleeding mucosal erosions were present within the colon; at the hepatic flexure, transverse colon, and sigmoid colon. The overall impression was ileo-colonic Crohn’s disease with moderately severe and active ileal disease. Biopsies gave histopathological confirmation of moderately active ileal Crohn’s disease with mild, patchy colonic inflammation. At diagnosis, his symptoms indicated a Harvey-Bradshaw Index (HBI) score of 17, indicating moderately severe disease [23].

Treatment was commenced January 2015 with the biologic agent infliximab, 5 mg/kg by intravenous infusion every 8 weeks. After 37 weeks, the treatment dose was escalated to 7.5 mg/kg due to lack of symptomatic clinical response. The patient’s symptoms improved, but he did not achieve clinical remission. After 1 year of infliximab treatment, his HBI score was 5, indicating mildly active disease. Although he had demonstrated significant clinical response to therapy, he had failed to achieve clinical remission and continued to experience fatigue, bloating, and episodic severe abdominal pain.
In March 2017, having been on infliximab for 2 years, the patient reported a complete elimination of animal products and processed foods from his diet for forty days during a period of religious observation. During this time, he experienced a complete resolution of symptoms (HBI 0). Prior to this, his diet had been the typical American diet consisting of daily consumption of meat, dairy products, refined grains, processed foods, and modest amounts of vegetables and fruits. Having experienced complete clinical remission for the first time since his Crohn’s disease diagnosis, the patient decided to switch to a whole food, plant-based diet permanently, severely reducing his intake of processed foods and limiting animal products to one serving, or less, per week. There were a few reported periods of poor diet adherence, at which point symptoms of fatigue, nausea, bloating, and occasional aphthous ulcers would recur (HBI 2). HBI scores decreased back to 0 with adherence to the plant-based diet. He also began to employ stress-relief strategies including yoga, weight-lifting, and running. After 6 months of implementing these changes in diet and lifestyle, a follow-up ileo-colonoscopy in August 2017 demonstrated complete mucosal healing with no visible evidence of Crohn’s disease (Figure 2).
One year after this follow-up colonoscopy, infliximab therapy was ceased based upon ongoing complete clinical remission. As of May 2019, the patient had been off standard medical therapy for a total of 10 months and had not yet experienced a significant clinical relapse.
Posted on: July 8 2019

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