Controlled trial of bowel rest and nutritional support in the management of Crohn's disease.

Greenberg, Gahl; Fleming, C. Richard; Jeejeebhoy, Khursheed N.; Rosenberg, Irwin H.; Sales, David J.; Tremaine, William J.

doi:10.1136/gut.29.10.1309

Cited by 273 publications

(95 citation statements)

References 19 publications

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“…A randomized controlled trial comparing TPN with EN or TPN given together with an oral diet in Crohn's disease did not show any increased complications due to TPN, and the rate or remission between the two modalities of Crohn's disease was the same (Greenberg et al 1998). In acute colitis it was shown that patients receiving TPN had an increased rate of sepsis; however, the rate of colectomy or remission of disease activity were not different between the two groups (Gonzalez-Huix et al 1993).…”

Section: Inflammatory Bowel Diseasementioning

confidence: 99%

Enteral and parenteral nutrition: evidence-based approach

Jeejeebhoy

2001

Proc. Nutr. Soc.

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Nutrition support for patients in hospital has become an essential form of therapy. Total parenteral nutrition (TPN) was the preferred way of giving nutrition to hospital patients for many years but enteral nutrition (EN) is now the preferred route. EN is believed to promote gut function and prevent translocation of intestinal bacteria, thus reducing the incidence of sepsis in critically ill patients. In consequence, the use of TPN has been discouraged as a dangerous form of therapy. Critical review of the data suggests that in the human subject TPN does not cause mucosal atrophy or increase translocation of bacteria through the small intestine. However, overfeeding, which is easy with TPN, can explain the results of studies which have shown that TPN increases sepsis. Furthermore, the risks of TPN-induced complications have been exaggerated. When there is risk of malnutrition and EN is not tolerated, or there is gut failure, TPN is an equally effective and safe alternative.

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Section: Inflammatory Bowel Diseasementioning

confidence: 99%

Enteral and parenteral nutrition: evidence-based approach

Jeejeebhoy

2001

Proc. Nutr. Soc.

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“…Rigaud 67 showed similar results with elemental and polymeric diets used as primary therapy for steroid-unresponsive CD. This fact suggests that some patients may benefit from NT after drug treatment failure 15 In a prospective study comparing TPN, oral diets plus TPN and elemental diets, Greenberg et al 31 observed no significant differences on remission, concluding that the benefits of these regimens were due to nutritional improvement. Recent literature reviews 22,50 and meta-analyses of controlled randomized trials 34 have not shown any significant difference between elemental, oligomeric and polymeric diets concerning initial or late remission of active CD, even though elemental diets are related to earlier remission.…”

Section: Enteral Nutrition (En)mentioning

confidence: 98%

“…Indication of primary TPN and bowel rest for acute active IBD is still controversial, since total bowel rest is not essential for disease remission 31 . Furthermore, it is well known that exclusive TPN leads to profound morpho-functional changes (mucous atrophy, bacterial translocation, enzyme and hormone alterations, intrahepatic cholestase, and macrophage dysfunction).…”

Section: Total Parenteral Nutrition (Tpn)mentioning

confidence: 99%

Inflammatory bowel diseases: principles of nutritional therapy

et al. 2002

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Inflammatory Bowel Diseases - ulcerative colitis and Crohn's disease- are chronic gastrointestinal inflammatory diseases of unknown etiology. Decreased oral intake, malabsorption, accelerated nutrient losses, increased requirements, and drug-nutrient interactions cause nutritional and functional deficiencies that require proper correction by nutritional therapy. The goals of the different forms of nutritional therapy are to correct nutritional disturbances and to modulate inflammatory response, thus influencing disease activity. Total parenteral nutrition has been used to correct and to prevent nutritional disturbances and to promote bowel rest during active disease, mainly in cases of digestive fistulae with high output. Its use should be reserved for patients who cannot tolerate enteral nutrition. Enteral nutrition is effective in inducing clinical remission in adults and promoting growth in children. Due to its low complication rate and lower costs, enteral nutrition should be preferred over total parenteral nutrition whenever possible. Both present equal effectiveness in primary therapy for remission of active Crohn's disease. Nutritional intervention may improve outcome in certain individuals; however, because of the costs and complications of such therapy, careful selection is warranted, especially in patients presumed to need total parenteral nutrition. Recent research has focused on the use of nutrients as primary treatment agents. Immunonutrition is an important therapeutic alternative in the management of inflammatory bowel diseases, modulating the inflammation and changing the eicosanoid synthesis profile. However, beneficial reported effects have yet to be translated into the clinical practice. The real efficacy of these and other nutrients (glutamine, short-chain fatty acids, antioxidants) still need further evaluation through prospective and randomized trials.

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“…TPN has also been shown to achieve fistula healing in 43-63% of patients, accompanied by disease activity reduction and weight gain (37,38). However, TPN does not seem to be better than EN or steroids in terms of efficacy (39). TPN was also associated with an increased risk of adverse events such as sepsis and cholestatic liver disease.…”

Section: Nutritional Induction Therapymentioning

confidence: 99%

Nutritional treatment in inflammatory bowel disease: An update

Guagnozzi

González-Castillo

Olveira

et al. 2012

Rev. esp. enferm. dig.

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Background and aims: enteral (EN) and parenteral (TPN) nutrition exert variable therapeutic effects on the induction and maintenance of remission in inflammatory bowel disease (IBD).This review aims to provide an updated discussion on the complex relationship between diet and IBD.Methods: medline, Cochrane and Scopus database searches were conducted. Sources cited in the articles obtained were also searched to identify other potential sources of information.Results: nutritional status is significantly compromised in IBD patients, especially those with Crohn's disease (CD). Apart from restoring malnourishment, dietary components contribute to modulate intestinal immune responses. Nutritional treatment is divided into support therapy and primary therapy to induce and maintain remission through TPN and EN. EN is considered a first-line therapy in children with active CD whereas it is usually used in adult CD patients when corticosteroid therapy is not possible. TPN has limited effects on IBD.En formula composition, in terms of carbohydrates, nitrogen source and bioactive molecules supplementation, differentially influence on IBD treatment outcomes. Other dietary components, such as poorly absorbed short-chain carbohydrate, polyols, and exogenous microparticles, also participate in the etiopathogenesis of IBD. Finally, new approaches to understanding the complex relationship between IBD and diet are provided by nutrigenenomic.Conclusion: further long-term, well-powered studies are required to accurately assess the usefulness of nutrition in treating IBD. In future research, the potential role of nutrient-gene interaction in drug trials and specific dietary formula compositions should be investigated in order to incorporate new knowledge about the etiopathology of IBD into nutritional intervention.

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Controlled trial of bowel rest and nutritional support in the management of Crohn's disease.

Cited by 273 publications

References 19 publications

Enteral and parenteral nutrition: evidence-based approach

Enteral and parenteral nutrition: evidence-based approach

Inflammatory bowel diseases: principles of nutritional therapy

Nutritional treatment in inflammatory bowel disease: An update

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