Impact of Elemental Diet on Mucosal Inflammation in Patients with Active Crohnʼs Disease: Cytokine Production and Endoscopic and Histological Findings

Yamamoto, Takayuki; Nakahigashi, Maki; Umegae, Satoru; Kitagawa, Tatsushi; Matsumoto, Koichí

doi:10.1097/01.mib.0000161307.58327.96

Cited by 164 publications

(155 citation statements)

References 40 publications

(126 reference statements)

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“…Elemental feeds were originally designed by the National Aeronautics and Space Administration (NASA) as easily digestible, water-soluble foods that produced smaller faecal bulk when consumed in space [Winitz et al 1965]. There is clear evidence that elemental feeds have a primary anti-inflammatory effect in CD, with evidence of improved intestinal permeability [Teahon et al 1991], reduced inflammatory cytokine production [Yamamoto et al 2005;Sanderson and Croft, 2005] and mucosal healing [Yamamoto et al 2005], although only when given exclusively [Johnson, 2006]. Various theories have been proposed as to how these benefits are rendered [O'Sullivan and O'Morain, 1998], but a definitive answer is lacking.…”

Section: Induction Of Remission: Enteral Nutritionmentioning

confidence: 99%

Nutritional management of Crohn’s disease

Donnellan

Lee

Lal

2013

Therap Adv Gastroenterol

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Nutritional care and therapy forms an integral part of the management of patients with Crohn's disease (CD). Nutritional deficiencies result from reduced oral intake, malabsorption, medication side effects and systemic inflammation due to active disease. Enteral nutrition has a role in support for the malnourished patient, as well as in primary therapy to induce and maintain remission. The use of parenteral nutrition in CD is mainly limited to the preoperative setting or for patients with intestinal failure, but does not offer any additional advantage over EN in disease control. Dietary modifications, including eliminationreintroduction diets and a low fermentable, oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) diet may improve symptoms but there are currently no data to suggest that these approaches have any role in the induction or maintenance of remission.

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Section: Induction Of Remission: Enteral Nutritionmentioning

confidence: 99%

Nutritional management of Crohn’s disease

Donnellan

Lee

Lal

2013

Therap Adv Gastroenterol

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“…A number of studies suggest that EN promotes the balancing of mucosal cytokines – by decreasing those which are pro-inflammatory [30, 31], restores mucosal integrity and its barrier function [24, 30, 32], decreases adjacent mesenteric fat inflammation [33, 34], and alters the composition of the intestinal microbiome [35, 36]. It is possible that bowel rest and interruption of exposure to alimentary and some bacterial allergens may be contributing mechanisms [29].…”

Section: Introductionmentioning

confidence: 99%

Preoperative Enteral Nutrition and Surgical Outcomes in Adults with Crohn’s Disease: A Systematic Review

Rocha

Bessa

Lago

et al. 2018

GE Port J Gastroenterol

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Background and Aim: Enteral nutrition (EN) is applicable to adult Crohn’s disease (CD) in treating malnutrition and in inducing remission – here as a less effective alternative than corticosteroids. The purpose of this review is to determine whether preoperative EN impacts postoperative complications of adult CD, either by means of nutritional or therapeutic effects. Summary: A systematic review of English written full-text research articles published between January 1990 and November 2017, including adult patients undergoing abdominal surgery for complicated CD after EN, was performed. Four studies out of 22 were selected, all of which institutional, retrospective, case-control cohorts, one classified as “good quality” and three as “poor quality,” as rated by the Newcastle-Ottawa Scale. The application of inclusion and exclusion criteria resulted in a non-intentional absence of studies referring to supplemental EN among those reviewed. The reduced number of heterogeneous eligible studies impeded meta-analysis. In all studies, exclusive EN (EEN) was used and well tolerated, allowing to defer or even avoid surgery altogether, improving patients’ global state. The two studies with the greatest number of patients found preoperative EEN to be an independent factor against infectious and non-infectious complications in 219 patients and against anastomotic leaks or abscesses in 38 patients. Also, in univariate analysis, EEN was found to increase preoperative immunosuppressant-free intervals and to protect against anastomotic dehiscences, intra-abdominal abscesses, surgical wound infections, ileus, stomas, and reoperations in the largest study; in another study it was related to fewer intra-abdominal septic complications. Key Messages: All reviewed studies are retrospective and, consequently, of limited relevance. Nonetheless, all of them call the attention of the scientific community to the potential benefits of preoperative EEN on postoperative outcomes in adult CD, calling for prospective multi-institutional studies and randomized controlled trials.

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“…[17][18][19][20] In our previous study, we investigated the impact of an elemental diet on clinical and endoscopic disease activities and mucosal cytokines in patients with active CD. 21 After a 4-week treatment, clinical remission was achieved in 71% of patients. Endoscopic healing and improvement rates were 44% and 76% in the terminal ileum, and 39% and 78% in the large bowel, respectively.…”

mentioning

confidence: 99%

Impacts of long-term enteral nutrition on clinical and endoscopic disease activities and mucosal cytokines during remission in patients with Crohnʼs disease: A prospective study

Yamamoto

Nakahigashi

Saniabadi

et al. 2007

Inflammatory Bowel Diseases

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Impact of Elemental Diet on Mucosal Inflammation in Patients with Active Crohnʼs Disease: Cytokine Production and Endoscopic and Histological Findings

Abstract: The elemental diet (Elental) reduced mucosal cytokine production and corrected an imbalance between proinflammatory and anti-inflammatory cytokines in CD.

Cited by 164 publications

References 40 publications

Nutritional management of Crohn’s disease

Nutritional management of Crohn’s disease

Preoperative Enteral Nutrition and Surgical Outcomes in Adults with Crohn’s Disease: A Systematic Review

Impacts of long-term enteral nutrition on clinical and endoscopic disease activities and mucosal cytokines during remission in patients with Crohnʼs disease: A prospective study

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