Low doses of MTX can inhibit the function of several enzymes related to DNA synthesis, and downregulate a variety of inflammatory cytokines [such as interleukin (IL)-1, IL-2, IL-6, IL-8, etc.], thus inhibiting the proliferation of T lymphocytes and inflammatory response ( 52). A study has found that 72% of patients with active CD achieved clinical remission after 3 months of MTX treatment ( 53). A randomized controlled trial has shown that in patients with CD who have clinical remission after intramuscular treatment with 25 mg MTX per week, the rate of maintenance remission at 40 weeks of intramuscular treatment with 15 mg MTX per week is 65%, higher than that of the control group (39%, P = 0.04) ( 54). MTX has not been proven to have efficacy in inducing remission in UC ( 55). In addition, MTX can cause fatigue, nausea, vomiting, diarrhea, peritoneal abscess, hypoalbuminemia, atypical pneumonia, severe rash, etc. ( 27, 55). Calcineurin Inhibitors

A second study looked at the effect of UCED in pediatric patients with mild-to-moderate active disease. 29 Patients were introduced to UCED for the first 6 weeks, and those in remission at week 6 received a step-down diet for another 6 weeks. Etrolizumab is a monoclonal antibody that selectively targe Dugelay E, et al. Dietary zinc intake and inflammatory bowel disease in the French NutriNet-Santé cohort. Am J Gastroenterol. 2020 Aug;115(8):1293-1297. The Low FODMAP Diet was originally developed for people with irritable bowel syndrome (IBS) as a way to reduce symptoms, but has also been shown to reduce symptoms in people with inflammatory bowel disease (IBD) who have overlapping IBS. However, the Low FODMAP diet has not been shown to reduce inflammation. Registered Dietitian & Researcher, Wolfson Medical Center, Tel Aviv Sourasky Medical Center, Tel Aviv University, Israelof Gastroenterology and Hepatology, Chinese People's Liberation Army General Hospital, Beijing, China A patient with an ileostomy was referred for CDED postoperatively to reduce his risk of postoperative recurrence as he was at risk of short bowel syndrome if he required further surgery and had failed multiple drug therapies.

Meets the RDI for adult patients in 2000ml per day; for children the RDI is met per volume appropriate for ageIn a 12-week prospective trial of children with mild to moderate CD conducted in 2019 1, children were randomly assigned to a group that received CDED plus 50% of calories from partial enteral nutrition (PEN, Modulen IBD) for 6 weeks (phase 1), followed by CDED with 25% PEN from weeks 7 to 12 (phase 2). Ananthakrishnan A, et al. A prospective study of long-term intake of dietary fiber and risk of Crohn's disease and ulcerative colitis. Gastroenterology. 2013 Nov;145(5):970-7.

However, TPs have many adverse side effects, such as bone marrow suppression ( 50), liver injury ( 51), and gastrointestinal intolerance ( 44), etc. It has been reported that up to 39% of patients with IBD discontinue using TPs due to adverse reactions, most of which occur within 3 months of treatment ( 44). The use of TPs in IBD treatment has declined due to concerns about adverse drug reactions. MTX For Crohn’s disease patients with mild-to-moderate symptoms, a Mediterranean style diet and the Specific Carbohydrate Diet™ (see below for more detailed description of this diet) appeared to similarly improve symptoms, inflammation, and quality of life over the course of 12 weeks, according to a study published in Gastroenterology and funded by the Crohn’s & Colitis Foundation and the Patient-Centered Outcomes Research Institute (PCORI). Consumption of dietary fibre was associated with reduced disease flares in patients with CD but not UC. 77 Recommendations to limit dietary fibre, as proposed in the low-residue diet often prescribed in patients with diarrhoea to enhance digestive comfort should be re-evaluated.The exact cause of IBD remains indistinct, but it is generally accepted that its etiopathology is multifactorial, involving genetic predisposition, mucosal barrier dysfunction, disturbances in the gastrointestinal microbiota, dysregulated immune responses, environmental, and lifestyle factors ( 3, 4).