Challenges in Managing Paediatric Crohn's Disease With Crohn's Disease Exclusion Diet (CDED): The First Single-Center Study in the United Arab Emirates.

BACKGROUND: Inflammatory bowel disease has been increasing significantly. For that, many modalities of treatment have shown promising results including a special diet. In our study, we looked at Crohn's disease dietary management for induction and subsequently maintenance of treatment. The research question was how feasible was applying this approach and what difficulties the patients and their parents faced. METHODOLOGY: We reviewed the electronic medical system. We had 32 paediatric patients who were diagnosed with Crohn's disease and used the special diet plan (Crohn's disease exclusion diet or exclusion enteral nutrition) to induce remission or maintenance. Then, we used a questionnaire to identify the difficulties they faced while using the special diet. RESULTS AND DISCUSSION: We have found that the cohort had used the special diet for a variable duration. The majority of patients opted to start with Crohn's disease exclusion diet. The clinical response was inconsistent due to poor compliance. Only 57 % of the patients were able to bear with the dietary plan beyond 12 weeks. Patients reported the following factors which caused non-compliance: intolerance/difficulty to follow (40%), cost (19%), poor clinical response (19%), and others. CONCLUSIONS: In managing Crohn's disease, a multidisciplinary approach, including dietary interventions, is crucial. However, adherence to specialized diets poses several challenges identified in this study based on patient feedback. Addressing barriers and prioritizing dietitians' role is essential for improved patient outcomes in inflammatory bowel disease management.

Unsuspected Langerhans cell histiocytosis can be easily missed in a colonic biopsy.

Langerhans cell histiocytosis (LCH) involvement of the gastrointestinal tract (GIT) is rare. The infiltrate in a colonic biopsy can be dissimilar to classic cytomorphologic features. It could be patchy, restricted to the subepithelial lamina propria and the lesional cells might have prominent nucleoli with lymphocytes-dominant background. The GIT manifestations could be confused with infectious, allergic, immunodeficiency and inflammatory bowel diseases. The rarity of GIT lesions, unawareness of some atypical endoscopic and histologic features might lead to false negative results. We report a case of LCH in an 11-month-old baby that was clinically unsuspected and histologically overlooked.