Clinical and Histologic Remission in an Adult Crohn's Disease Patient Following the Specific Carbohydrate Diet and Its Impact on Healthcare Costs

Crohn's disease (CD) is an immune-mediated inflammatory disorder of the gastrointestinal tract. While the etiology is not fully elucidated, the intestinal microbiome is believed to initiate and maintain immune activation in CD. The intestinal microbiome is highly responsive to its environment, including host dietary patterns. As such, dietary interventions have the potential to modulate intestinal microbiome composition and function and improve disease outcomes. We present a retrospective chart review of an adult male with complicated Crohn's disease who was non-responsive to medical management. The patient began the specific carbohydrate diet (SCD) in February 2017 and maintained it for 42 months. The patient tolerated the SCD well and has been asymptomatic for 40 months on the SCD. Stool fecal calprotectin (FCP) decreased from 493 ug/g at baseline to 70 ug/g at month three and remained in the normal range thereafter. Endoscopy with biopsy at month 12 showed normal histology in the colon and terminal ileum. Magnetic resonance enterography (MRE) showed resolution of prior jejunal inflammation. Inflammatory bowel disease (IBD) associated healthcare costs were $42,688 in the 12 months preceding the intervention and $2,797/year with SCD. This represented a 94% reduction in healthcare insurance costs and a 91% reduction in out-of-pocket patient expenses. This case highlights the rapid and sustainable benefits of the SCD intervention in Crohn's disease from both a clinical and economic standpoint.