Standard versus rapid food reintroduction after exclusive enteral nutritional therapy in paediatric Crohn’s disease

Faiman, Abi; Mutalib, Mohamed; Moylan, Alexander; Morgan, Natalie; Crespi, Daniel; Furman, M; Kader, Ajmal

doi:10.1097/meg.0000000000000027

Cited by 25 publications

(29 citation statements)

References 24 publications

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“…Formula can be reduced in volume and frequency, whilst food is reintroduced one meal at a time over a period of 5 days (Fig. ) …”

Section: Resultsmentioning

confidence: 99%

“…Food can be reintroduced at a rapid pace as tolerated by the individual without risk of reducing EEN efficacy (Fig. ) . If the individual is reluctant to reintroduce food rapidly, a slower approach can be taken to support emotional needs and balance nutritional intake.…”

Section: Resultsmentioning

confidence: 99%

“…2). 43 If the individual is reluctant to reintroduce food rapidly, a slower approach can be taken to support emotional needs and balance nutritional intake.…”

Section: All Members Of the Ibd Multidisciplinary Team (Mdt) Shouldmentioning

confidence: 99%

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Exclusive enteral nutrition: An optimal care pathway for use in adult patients with active Crohn's disease

et al. 2019

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Background and Aim Exclusive enteral nutrition (EEN) is progressively being used as a therapeutic option for adults with Crohn's Disease (CD); however, there is no standardized approach to delivering this therapy. The aim of this study is to develop an optimal care pathway for using EEN in adults with CD. This will create a standard of care that can be used as a benchmark practice and will provide direction for future research. Methods A working group of 12 multidisciplinary inflammatory bowel disease specialists across Australia and New Zealand was convened to develop a practical, clinically focused care pathway for using EEN in adults with active CD. Six key areas were identified as part of the care pathway: clinical indications, nutrition assessment, EEN protocol, monitoring, accessing formula, and food reintroduction. Current literature was identified via systematic review, and quality of evidence was graded. Consensus expert opinion was used where literature gaps were identified. Results An optimal care pathway for using EEN in adults with CD was developed with six key consensus statements on how to use EEN in adults with active CD. These key statements identify clinical indications for use, nutrition assessment, enteral prescription and duration of therapy, monitoring criteria, food reintroduction, and the role of partial EEN. An accompanying patient resource was also developed. Conclusion EEN is recommended as a treatment option to induce remission in adults with active CD. The consensus statements developed are practical and are based on best available evidence and expert opinion to assist in developing a standardized approach to delivering EEN therapy.

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“…Formula can be reduced in volume and frequency, whilst food is reintroduced one meal at a time over a period of 5 days (Fig. ) …”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Exclusive enteral nutrition: An optimal care pathway for use in adult patients with active Crohn's disease

et al. 2019

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“…The differences include type of foods reintroduced (ranging from minimal or no restriction to allowing very specific foods) and the duration of such reintroduction, ranging anywhere between 1–12 weeks. One center compared 2 different methods of reintroduction of solid foods after EEN using data collected at their center during 2 consecutive time periods . Where their local practice changed in the first time period, they reintroduced food slowly and they asked patients to introduce new foods gradually in a process that would take at least 5 weeks to return to typical diet.…”

Section: Factors Potentially Affecting the Efficacy Of Enmentioning

confidence: 99%

“…One center compared 2 different methods of reintroduction of solid foods after EEN using data collected at their center during 2 consecutive time periods. 56 Where their local practice changed in the first time period, they reintroduced food slowly and they asked patients to introduce new foods gradually in a process that would take at least 5 weeks to return to typical diet. In the second time period, they implemented a rapid reintroduction of food where they asked patients to consume a low-residue diet for 3 days and then reestablish their former unrestricted diet.…”

Section: Reintroduction Of Solid Food After Eenmentioning

confidence: 99%

Enteral Nutrition for Pediatric Crohn's Disease: An Underutilized Therapy

Shaikhkhalil

Crandall

2018

Nut in Clin Prac

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Enteral nutrition (EN) for the treatment of Crohn's disease (CD) involves administration of a liquid nutrition product, administered orally or through tube feeding, while excluding typical dietary components. It is a safe and effective, but largely underused, therapy in the United States as a treatment for CD. EN is a particularly attractive option for pediatric CD as it avoids side effects of corticosteroids, improves growth, and may have a higher likelihood of achieving mucosal healing than some traditional medications. However, there are multiple real and perceived barriers to its use among providers. A comprehensive approach to addressing these barriers to EN may result in its increased use. This paper reviews the literature on the efficacy of EN, methods of utilization, and potential barriers and solutions to those barriers.

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Exclusive enteral nutrition in children with inflammatory bowel disease: Physician perspectives and practice

2018

JGH Open

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Background and Aim Exclusive enteral nutrition (EEN) is recognized internationally as the first line of treatment for children with active Crohn's disease (CD). A survey conducted a decade ago demonstrated that 40% of Australian pediatric gastroenterologists did not think EEN to be an appropriate treatment for CD. This study aimed to explore the current attitudes of Australian and New Zealand (NZ) pediatric gastroenterologists toward the use of EEN in children with inflammatory bowel disease (IBD). Methods All practicing pediatric gastroenterologists in Australia and NZ were invited via an existing email network to complete an anonymous online questionnaire. Results The questionnaire was completed by 37 respondents (54% response rate), 31 from Australia and 6 from NZ. All respondents felt that EEN definitely or probably has a role in inducing remission for children with newly diagnosed CD. Australian gastroenterologists were more likely to use EEN for relapsed CD or IBD‐unclassified than NZ doctors (P < 0.05). Adherence was reported to be the greatest disadvantage of EEN. Dietitians were believed to play the most crucial role in EEN administration. Variations in EEN protocols included the use of flavorings or fluids during EEN and different patterns of food reintroduction. Conclusions These Australia and NZ pediatric gastroenterologists felt that EEN plays an important role in the induction of remission in children with newly diagnosed CD. However, the perceived role of EEN use in other types of IBD varied. EEN protocols varied widely between centers. Attitudes toward the roles of EEN have altered greatly across Australasia over the last decade.

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Standard versus rapid food reintroduction after exclusive enteral nutritional therapy in paediatric Crohn’s disease

Cited by 25 publications

References 24 publications

Exclusive enteral nutrition: An optimal care pathway for use in adult patients with active Crohn's disease

Exclusive enteral nutrition: An optimal care pathway for use in adult patients with active Crohn's disease

Enteral Nutrition for Pediatric Crohn's Disease: An Underutilized Therapy

Exclusive enteral nutrition in children with inflammatory bowel disease: Physician perspectives and practice

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