Due to both perceived and real risks of current medical therapies for Crohn's disease (CD), other safe and effective approaches, particularly those utilizing nutrition and enteral therapy, have been sought. The specific carbohydrate diet (SCD) has become one alternative for CD considered by parents and patients, yet no prospective pediatric trials which employ mucosal healing as an outcome exist. Methods: Pts with active CD (PCDAI ≥ 15) interested in the SCD as adjunctive therapy and able to swallow a video capsule (VC), were eligible for this study. Subjects underwent a patency capsule, and if passed intact, VC was administered. They were maintained on their prescribed medications and reviewed the SCD with a dietician who then monitored their intake. VC was then repeated at 12 weeks(wk). Demographic, dietary and clinical information were collected at both time points. VC at wks 0 and12 were evaluated by a reader blinded to patient results and timing. PCDAI, Harvey Bradshaw (HB) and Lewis score (LS) were calculated at study visits as well. Means for outcome variables are reported here because of the few pts enrolled as yet. Results: The SCD has been offered to 10 pts to date. Two declined because of the stringency of the SCD; 2 were unable to ingest the VC; with 6 enrolled. Four (2 M, 2 F; average age 13.5 y; disease duration 4.5 y) have completed the trial to date; 1 (20 yo F) ceased at 8 wk because of difficulty with the SCD. The 4 completers received an average of 72.4 % of their estimated caloric needs, respectively, prior to the SCD, and 82.6 % on the SCD. Weight, Hgb, WBC, ESR, and albumin were essentially unchanged. Mean HB decreased from 3 to 1 and PCDAI from 20 to 6.2. Small bowel (SB) ulcers seen on initial VC in 3 were not seen on the 12 wk VC, with LS decreasing in all pts. In1 pt not rigidly adherent to the SCD, the number of stenotic areas decreased and the LS declined, but additional aptha developed in a new location. Impressions: Mucosal and clinical improvement were seen in the first 4 patients completing this pilot study (with SB mucosal healing in 2). VC appears to offer an important means to monitor mucosal improvement even over a relatively short interval. Completion of this trial and additional studies are needed to understand the changes described here and the mechanisms contributing to this improvement.