If positive for gliadin sensitivity, a gluten restricted trial diet for 30 to 90 days would be appropriate.

The following should also be considered in your clinical management:

Rule out Helicobacter Pylori may help treat Crohn’s disease. Researchers recently reported that “after treatment [with antibiotics against H. Pylori], clinical remission of Crohn’s disease was achieved in all patients”, regardless of the type of therapy received.

Rule out dysbiosis. Establish the concentration of lactobacilli and bifidobacteria

Evaluate omega 3 levels.  A clinical study found that Crohn’s patients had lower concentrations of Omega-3 essential fats. Among the fatty acids that correlated with the Crohn’s disease activity index, EPA and total Omega-3 polyunsaturated fatty acids showed the most significant negative correlations. The less of these fatty acids present, the worse the disease.

Consider ordering a comprehensive digestive stool analysis and a fatty acid profile.

References:

1. Mate J, Castanos R, Garcia-Samaniego J, Pajares JM. Does dietary fish oil maintain the remission of Crohn’s disease: a case control study. Gastroenterology 1991;100:A228 [abstract].
2. Belluzzi A, Brignola C, Campieri M, et al. Effect of an enteric-coated fish-oil preparation on relapses in Crohn’s disease. N Engl J Med 1996;334:1557–60.
3. Lorenz R, Weber PC, Szimnau P, et al. Supplementation with n-3 fatty acids from fish oil in chronic inflammatory bowel disease—a randomized, placebo-controlled, double-blind cross-over trial. J Intern Med Suppl 1989;225:225–32.
4. Lorenz-Meyer H, Bauer P Nicolay C, et al. Omega-3 fatty acids and low carbohydrate diet for maintenance of remission in Crohn’s disease. A randomized controlled multicenter trial. Study Group Members (German Crohn’s Disease Study Group). Scand J Gastroenterol 1996;31:778–85.
5. Belluzzi A, Brignola C, Campieri M, et al. Effects of new fish oil derivative on fatty acid phospholipid-membrane pattern in a group of Crohn’s disease patients. Dig Dis Sci 1994;39:2589–94.
6. Fatty Acid Patterns in Patients with Chronic Intestinal Disease, Metabolism 1996; 45(1): pp.12-23]

Ron Grisanti, D.C.

(If possible in the future, rule out mycobacterium paratuberculosis (Para-T) RNA. Mycobacterium paratuberculosis was found in 100% of Crohn’s disease patients, compared with 0% of controls.  This bacteria becomes cultured in milk, and is not destroyed by normal pasteurization. Para-T crosses the species barrier to infect and cause disease in humans. Occasionally, the milk-borne bacteria will begin to grow in the human host, and irritable bowel syndrome and Crohn’s disease results.  Here’s an article to read on the subject.  At present, it is extremely difficult to test.)