Exclusive enteral nutrition in active pediatric Crohn disease: Effects on intestinal microbiota and immune regulation

Gut microbiota and IBD: causation or correlation?

“…ENT was effective in inducing remission in paediatric patients with Crohn's disease, and was associated with rapid changes in gut microbiota composition 37 . Another study further showed that ENT was associated with reduced numbers of T reg cells in the lamina propria, reflecting the resolution of intestinal inflammation 165 . Notably, favourable therapeutic outcomes of ENT that we and others have reported was associated with initial shifts in microbial composition towards even greater dysbiosis relative to healthy individuals 37,166 .…”

The Impact of Exclusive Enteral Nutrition (EEN) on the Gut Microbiome in Crohn’s Disease: A Review

“…The study primarily examined EEN-induced changes in six families within the Firmicutes phylum ( Erysipelotrichaceae , Ruminococcaceae , Lachnospiraceae , Streptococcaceae , Veillonellaceae and Peptostreptococcaceae ) and found, in general, that reduction in their relative abundance correlated with clinical improvement, though changes in specific families varied among study subjects [53]. In contrast, Schwerd et al reported that EEN treatment increased relative abundance of bacteria within the Firmicutes phylum, especially members of the Christensenellaceae family, and decreased relative abundance in members of the Bacteroidetes phylum (including Bacteroidaceae , Porphyromonadaceae and Rikenellaceae ) in eight patients undergoing EEN [54]. …”

Enteral nutrition is associated with a decreased risk of surgical intervention in Crohn’s disease patients with spontaneous intra-abdominal abscess

“…This restoration of gut barrier morphology and function is closely related with a mechanism involving the inhibition of long myosin light chain kinase (MLCK) (39). Moreover, previous studies (23,25,29,40,41) have indicated that EN modulates the gut microbiota which is linked with CD disease activity and thus exerts a beneficial effect on the recovery of bowel function. Interestingly, it was suggested that ileal enterocytes might experience nutrient stress during EN treatment as the amino acid requirements of enterocytes were primarily provided by first pass catabolism of a lumen-supplied dietary amino acids and enterocytes were limited in their ability to utilize arterial supplied amino acids (42).…”

“…EN serves as an adjunctive therapy and has been widely used in a variety of diseases including abdominal sepsis (16), pancreatitis (17,18) and inflammatory bowel diseases (IBD) (5,(19)(20)(21)(22). A large body of evidence (5,8,21,(23)(24)(25)(26)(27)(28)(29)(30) suggests a beneficial role of EN in the management of CD. It is well known that malnutrition is common in CD patients.…”