Chronic Recurrent Multifocal Osteomyelitis Associated with Crohn Disease: A Potential Role of Exclusion Diet? Comment on Starz et al. The Modification of the Gut Microbiota via Selected Specific Diets in Patients with Crohn's Disease. Nutrients 2021, 13, 2125

The efficacy of diet and its influence on gut microbiome composition has been largely demonstrated in inflammatory bowel disease (IBD). Little is known about its potential in the management of extraintestinal manifestations. We report a successful application of Crohn disease exclusion diet (CDED) in association with infliximab and methotrexate, as salvage therapy in a child affected by chronic recurrent multifocal osteomyelitis (CRMO) and Crohn disease (CD) resistant to optimized therapy. Both intestinal and bone symptoms remitted after the application of CDED. Diet may have acted on common microbic inciting agents that trigger both intestinal and bone inflammation, supporting the role of microbiota in the pathogenesis of IBD-associated extraintestinal manifestations. Our experience suggests the potential benefit of CDED in association with combined therapy in resistant patients affected by CD and extraintestinal manifestations.

Automated summary

The efficacy of diet and its influence on gut microbiome composition in inflammatory bowel disease (IBD) has been well demonstrated, but its potential in managing extraintestinal manifestations remains unclear. The authors reported a case of a child with chronic recurrent multifocal osteomyelitis (CRMO) and Crohn disease (CD) who responded successfully to Crohn disease exclusion diet (CDED) in combination therapy, indicating the potential benefit of diet in resistant patients with CD and extraintestinal manifestations.