Preventive effect of nutritional therapy against postoperative recurrence of Crohn disease, with reference to findings determined by intra-operative enteroscopy

Abstract

EN is a prophylactic that prevents the postoperative recurrence of small intestinal CD. Patients with the penetrating type of CD, and those who do not have active lesions in the small intestine according to IOE, are candidates for EN after surgery.

Enteral nutrition in adult Crohn's disease: Present status and perspectives

“…Finally, mucosal IL-1b, IL-6 and TNF-a concentrations which do not differ at inclusion between the two groups, were significantly higher in the control group at 6 and 12 months compared to the EN group were they remain stable during the whole study period [24]. Two other studies (both performed in Japan) evaluate the effect of EN supplementation on postoperative recurrence [70,72]. Esaki et al [70] reported a decrease in postoperative recurrence in 21 patients taking more than 1200 kcal/day of EN compared to 18 patients who did not reach an intake of 1200 kcal/ day of EN; EN reduced the cumulative rate of postoperative relapse (p = 0.017), especially in those with penetrating type of disease (p = 0.005), in those who did not have colitis (p = 0.051), and in patients who did not have active mucosal lesions at intra-operative endoscopy exploring the remaining small bowel (p = 0.02).…”

“…One common feature of all studies is that EN was used in addition to normal food intake (representing at least 50% of total calorie intake), either as a nightly tube feeding, or as an oral supplement [24, 65 -72]. Recent controlled studies include those of Verma et al [68], Takagi et al [71] and Yamamoto et al [24], related to maintenance after remission induction has been obtained by medical treatment, and those of Esaki et al [70] and Yamamoto et al [72] after surgical resection. All studies demonstrate a benefit of EN support in addition to normal diet.…”

Postoperative Therapy for Crohnʼs Disease

“…50 For postoperative prophylaxis, Esaki et al 51 retrospectively evaluated the effects of supplemental EN on endoscopic recurrence among 40 patients. Patients were advised to receive either an elemental or polymeric diet postoperatively.…”

“…Separating the patients into those receiving Ͼ1200 kcal/day supplemental EN or Ͻ1200 kcal/day, the authors report a reduced rate of cumulative postoperative clinical recurrence among those receiving greater amounts of supplemental EN compared to those receiving less (46% versus 75% respectively). 51 This trial was not blinded, patients were only "advised" to take EN, and the endoscopic assessments were not standardized, limiting the significance of the findings.…”

Letter: enteral nutrition therapy for the induction of remission in paediatric Crohn's disease—Authors’ reply

“…The North American society for paediatric gastroenterology and the European society for clinical nutrition and metabolism guidelines both determined enteral nutrition to be an appropriate induction treatment for patients with Crohn's disease, with the latter updated EEN as induction therapy with "strong concensus." 6,7 Lastly, while Esaki et al 8 "found that Crohn's disease patients…”