Impact of long‐term enteral nutrition on clinical and endoscopic recurrence after resection for Crohn's disease: a prospective, non‐randomized, parallel, controlled study

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

doi:10.1111/j.1365-2036.2006.03158.x

Cited by 129 publications

(126 citation statements)

References 15 publications

(20 reference statements)

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“…The study and participant characteristics of the five included nRCTs 28,51,[56][57][58] are summarised in Table 2. Of five studies, four were conducted in Japan 28,51,57,58 and one in the UK.…”

Section: Non-randomised Controlled Trialsmentioning

confidence: 99%

“…The full text of the remaining 36 records was examined, of which 12 (representing eight unique studies) were included in the review. 28,[50][51][52][53][54][55][56][57][58][59][60] Of the eight included studies, one RCT [52][53][54] and one nRCT 28,59,60 were represented in multiple publications. Throughout this review, these two studies will be cited according to their corresponding original publications.…”

Section: Literature Searchmentioning

confidence: 99%

“…28 For example, in Japan, enteral nutrition is recommended as the first-line treatment in the management of active CD. 31,35 It has also been recommended by the European Society of Parenteral and Enteral Nutrition as first-line therapy in children and young adults with concerns about growth and side effects if corticosteroid therapy is not appropriate.…”

Section: Enteral Nutrition As Induction Therapymentioning

confidence: 99%

“…Several hypothesised mechanisms underlying the proposed benefits of enteral nutrition in CD include reduced gut activity, reduction of antigenic load, nutritional effects, anti-inflammatory effects or modulation of immune system and gastrointestinal flora. [28][29][30][31] Types and route of administration l As exclusive enteral nutrition (EEN): provided especially as a sole dietary source and a primary medical therapy to induce remission. l As partial enteral nutrition (PEN): given additionally to normal unrestricted/restricted diet, to improve nutritional status and/or to maintain remission.…”

Section: Summary Of Interventionmentioning

confidence: 99%

“…Throughout this review, these two studies will be cited according to their corresponding original publications. 28,52 The search of on-going trials in the UKCRN Portfolio and WHO ICTRP databases, which includes Clinical Trials.gov and Current Controlled Trials, (carried out in September 2013), retrieved 26 potentially relevant records, none of which was deemed relevant for inclusion in the review.…”

Section: Literature Searchmentioning

confidence: 99%

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Clinical effectiveness and cost-effectiveness of elemental nutrition for the maintenance of remission in Crohn’s disease: a systematic review and meta-analysis

Tsertsvadze

Gurung

Court

et al. 2015

Health Technology Assessment

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BackgroundAlthough enteral nutrition has been shown to be a viable treatment option for the management of active Crohn’s disease (CD), the evidence regarding its clinical benefits compared with standard treatments (e.g. steroids) for maintaining remission in patients with CD has been inconsistent. If enteral nutrition was to be effective, the use of drugs such as steroids and immunosuppressive drugs could be reduced, thereby reducing the likelihood of adverse events associated with these medications.ObjectivesThis systematic review aimed to assess the clinical effectiveness and cost-effectiveness of elemental nutrition (a type of enteral nutrition) for maintenance of remission in patients with CD.Data sourcesMajor bibliographic databases (e.g. MEDLINE, EMBASE, Cochrane Database of Systematic Reviews) were searched from inception to August/September 2013. Searches were not limited by study design, language or publication date. Websites for relevant organisations and references of included studies were checked.MethodsExperimental randomised and non-randomised controlled trials (RCTs and nRCTs) reporting clinical effectiveness and cost-effectiveness of elemental nutrition in the maintenance of remission in patients with CD were eligible. Study selection, data extraction and risk of bias (RoB) assessment were performed independently. Risk ratios (RRs) and mean differences (MDs) were pooled using a random-effects model. Heterogeneity was assessed via forest plots, Cochran’sQand theI2statistics. Overall, quality of evidence for each outcome was rated using the Grading of Recommendations, Assessment, Development, and Evaluation approach.ResultsEight studies (three RCTs and five nRCTs) were included in the review. RCTs indicated a significant benefit of elemental nutrition vs. no intervention (an unrestricted diet) in maintaining remission at 24 months [one RCT; RR 2.06, 95% confidence interval (CI) 1.00 to 4.43; very low-grade evidence] and preventing relapse at 12–24 months post baseline (two RCTs; pooled RR 0.57, 95% CI 0.38 to 0.84;I2 = 0%; high-grade evidence). Similarly, three nRCTs showed significant benefits of elemental nutrition over no intervention in maintaining remission at 12–48 months and preventing relapse at 12 months post baseline (MD 1.20 months, 95% CI 0.35 to 2.04 months). The incidence of mucosal healing was not significantly different in the intervention and control groups (RR 2.70, 95% CI 0.62 to 11.72). Adherence to an elemental nutrition regime was significantly worse than adherence to polymeric nutrition (RR 0.68, 95% CI 0.50 to 0.92) and, when compared with other active treatments (medications, polymeric nutrition or a combination), elemental nutrition yielded non-significant results with wide 95% CIs, rendering these results inconclusive. Complications and adverse events were too sparse to allow meaningful comparisons. None of the studies reported cost-effectiveness of elemental nutrition. Owing to scarcity of data, subgroup and sensitivity analyses could not be performed to explore methodological and clinical sources of heterogeneity.LimitationsThe findings warrant cautious interpretation given the limitations of the evidence in methodological quality (small samples, short follow-up) and the RoB in individual studies (lack of blinding, confounding).ConclusionsLimited evidence indicates potential benefits of elemental nutrition against no intervention in the maintenance of remission and prevention of relapse in adult patients with CD. There was a lack or insufficient evidence on adverse events and complications. Future large and long-term randomised trials are warranted to draw more definitive conclusions regarding the effects of elemental nutrition in maintaining remission in CD.Trial registrationThis study is registered as PROSPERO CRD42013005134.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: Non-randomised Controlled Trialsmentioning

confidence: 99%

Section: Literature Searchmentioning

confidence: 99%

Section: Enteral Nutrition As Induction Therapymentioning

confidence: 99%

Section: Summary Of Interventionmentioning

confidence: 99%

Section: Literature Searchmentioning

confidence: 99%

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Clinical effectiveness and cost-effectiveness of elemental nutrition for the maintenance of remission in Crohn’s disease: a systematic review and meta-analysis

Tsertsvadze

Gurung

Court

et al. 2015

Health Technology Assessment

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Oral protein calorie supplementation for children with chronic disease

Poustie

Smyth

Watling

1999

Cochrane Database of Systematic Reviews

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Oral protein calorie supplementation for children with chronic disease

Smith

Saljuqi²,

Watling

2015

Cochrane Database of Systematic Reviews

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Background Poor growth and nutritional status are common in children with chronic diseases. Oral protein calorie supplements are used to improve nutritional status in these children. These expensive products may be associated with some adverse effects, e.g. the development of inappropriate eating behaviour patterns. This is a new update of a Cochrane review last updated in 2009. Objectives To examine evidence that in children with chronic disease, oral protein calorie supplements alter daily nutrient intake, nutritional indices, survival and quality of life and are associated with adverse effects, e.g. diarrhoea, vomiting, reduced appetite, glucose intolerance, bloating and eating behaviour problems. Search methods Trials of oral protein calorie supplements in children with chronic diseases were identified through comprehensive electronic database searches, handsearching relevant journals and abstract books of conference proceedings. Companies marketing these products were also contacted. Most recent search of the Group's Trials Register: 24 February 2015. Selection criteria Randomised or quasi‐randomised controlled trials comparing oral protein calorie supplements for at least one month to increase calorie intake with existing conventional therapy (including advice on improving nutritional intake from food or no specific intervention) in children with chronic disease. Data collection and analysis We independently assessed the outcomes: indices of nutrition and growth; anthropometric measures of body composition; calorie and nutrient intake (total from oral protein calorie supplements and food); eating behaviour; compliance; quality of life; specific adverse effects; disease severity scores; and mortality; we also assessed the risk of bias in the included trials. Main results Four studies (187 children) met the inclusion criteria. Three studies were carried out in children with cystic fibrosis and one study included children with paediatric malignant disease. Overall there was a low risk of bias for blinding and incomplete outcome data.Two studies had a high risk of bias for allocation concealment. Few statistical differences were found in the outcomes we assessed between treatment and control groups, except change in total energy intake at six and 12 months, mean difference 304.86 kcal per day (95% confidence interval 5.62 to 604.10) and mean difference 265.70 kcal per day (95% confidence interval 42.94 to 485.46), respectively. However, these were based on the analysis of just 58 children in only one study. Only two chronic diseases were included in these analyses, cystic fibrosis and paediatric malignant disease. No other studies were identified which assessed the effectiveness of oral protein calorie supplements in children with other chronic diseases. Authors' conclusions Oral protein calor...

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Impact of long‐term enteral nutrition on clinical and endoscopic recurrence after resection for Crohn's disease: a prospective, non‐randomized, parallel, controlled study

Abstract: SUMMARY BackgroundThe impact of enteral nutrition on post-operative recurrence has not been properly examined.

Cited by 129 publications

References 15 publications

Clinical effectiveness and cost-effectiveness of elemental nutrition for the maintenance of remission in Crohn’s disease: a systematic review and meta-analysis

Clinical effectiveness and cost-effectiveness of elemental nutrition for the maintenance of remission in Crohn’s disease: a systematic review and meta-analysis

Oral protein calorie supplementation for children with chronic disease

Oral protein calorie supplementation for children with chronic disease

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