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, Takayuki; Nakahigashi, Maki; Saniabadi, Abbi R.; Iwata, Tadahisa; Maruyama, Yasuki; Umegae, Satoru; Matsumoto, Koichí

doi:10.1002/ibd.20238

Cited by 125 publications

(128 citation statements)

References 38 publications

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“…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%

“…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%

“…Of five studies, four were conducted in Japan 28,51,57,58 and one in the UK. 56 A total of 236 participants were assigned to the study treatments and the number of participants across the studies ranged from 39 56 to 61.…”

Section: Non-randomised Controlled Trialsmentioning

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: Literature Searchmentioning

confidence: 99%

Section: Non-randomised Controlled Trialsmentioning

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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“…In the case of EN, only one study has shown that during the fol-low-up period, CD patients in whom remission was induced by parenteral nutrition presented lower recurrence rates if they were kept on EN compared to those who were not (56). Indeed, available evidence suggests that supplementary EN may be effective as an alternative or adjunct therapy for maintaining remission in adult CD patients (57) (62). However, in order to confirm these findings, more extensive well-powered studies are needed, especially trials comparing EN with azathioprine and infliximab, which are known to be effective in maintaining remission in CD patients.…”

Section: Nutritional Maintenance 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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“…Enteral nutrition (EN), administered orally or via tube feeds, reduces inflammatory markers [8] and mucosal cytokines [9], while improving gut permeability [10] and modifying gut flora [11]. In one non-randomized trial, the relapse rate at 1 year was 25 % in the EN group versus 65 % in the non-EN group, with reported significant improvement in average endoscopy scores, with decreased mucosal concentrations of IL-1b, -6, and TNF [9]. In a meta-analysis of seven studies, EN with elemental, semi-elemental or polymeric diets orally or via tube feeds had higher clinical remission rates compared to groups ingesting ordinary foods [12].…”

mentioning

confidence: 99%

Diet Affects Symptoms and Medication Response in Inflammatory Bowel Disease

Pabby

Friedman

2013

Dig Dis Sci

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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

Abstract: Long-term enteral nutrition in patients with quiescent CD has a clear suppressive effect on clinical and endoscopic disease activities and the mucosal inflammatory cytokine levels.

Cited by 125 publications

References 38 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

Nutritional treatment in inflammatory bowel disease: An update

Diet Affects Symptoms and Medication Response in Inflammatory Bowel Disease

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