Preoperative Nutritional Conditioning of Crohn’s Patients—Systematic Review of Current Evidence and Practice

Abstract

Crohn’s disease is an incurable and frequently progressive entity with major impact on affected patients. Up to half of patients require surgery in the first 10 years after diagnosis and over 75% of operated patients require at least one further surgery within lifetime. In order to minimize surgical risk, modifiable risk factors such as nutritional status need to be optimized. This systematic review on preoperative nutritional support in adult Crohn’s patients between 1997 and 2017 aimed to provide an overview on target populations, screening modalities, routes of administration, and expected benefits. Pertinent study characteristics (prospective vs. retrospective, sample size, control group, limitations) were defined a priori. Twenty-nine studies were retained, of which 14 original studies (9 retrospective, 4 prospective, and 1 randomized controlled trial) and 15 reviews. Study heterogeneity was high regarding nutritional regimens and outcome, and meta-analysis could not be performed. Most studies were conducted without matched control group and thus provide modest level of evidence. Consistently, malnutrition was found to be a major risk factor for postoperative complications, and both enteral and parenteral routes were efficient in decreasing postoperative morbidity. Current guidelines for nutrition in general surgery apply also to Crohn’s patients. The route of administration should be chosen according to disease presentation and patients’ condition. Further studies are needed to strengthen the evidence.

Enteral Nutrition in Adult Crohn’s Disease: Toward a Paradigm Shift

“…If clinically permitted, EN should be preferred as the first feeding route, since its use has a trophic effect on the gut and stimulates bowel motility [34]. In terms of adverse effects, parenteral nutrition can be associated with higher morbidity compared to EN, in terms of sepsis, catheter-related blood stream infections, thromboses, and liver dysfunction [34,145,149,150].…”

“…Additional review articles similarly emphasise the need for pre-operative EN for surgical optimization [160,161]. An algorithm has been suggested by Grass et al [149] to implement current guidelines on perioperative EN and PN.…”

Guidelines for Clinical Nutrition in Inflammatory Bowel Disease

“…29 Osim što je u sustavnom pregledu literature pokazano da je mal nutricija glavni rizični faktor za postoperativne kompli kacije, pokazano je da su i enteralna i parenteralna nutritivna potpora učinkovite u sniženju postoperativnog morbiditeta. 87 Ubrzani oporavak nakon operacije (engl. Enhanced recovery after surgery -ERAS) ubrzava rehabilitaciju i povoljno djeluje na duljinu boravka u bolnici.…”

Prevalence and Consequences of Preoperative Weight Loss in Gynecologic Surgery

“…Preoperative conditioning, recognized as an efficient way to improve surgical outcomes, has been of growing interest in the last decades and endorsed by nutritional societies and perioperative care guidelines [1,2]. Nutritional support strategies have been evaluated and validated for different surgical specialties, including colorectal [3], hepatic [4], or gastric [5] surgery, and for more specific settings, such as surgery for Crohn’s disease [6].…”