Treatment of Active Crohn’s Disease with Exclusive and Partial Enteral Nutrition: A Pilot Study in Adults

Abstract

Background and Aim: Enteral nutrition (EN) is not commonly used for the treatment of adults with active Crohn’s disease (CD), despite patient interest in nutrition-based alternatives to corticosteroids and evidence of efficacy in paediatric CD. The aim of this study was to assess the impact of 2 different EN regimens on disease symptoms, nutrition and inflammatory markers in young adults with active CD. Methods: A prospective non-randomized pilot study of adults aged 16–40 years with active CD on endoscopy or imaging was undertaken. Patients were sequentially recruited to use 2 weeks of exclusive EN (EEN) followed by either 6 weeks of EEN or partial EN (PEN) with usual diet. Assessments of disease symptoms, nutrition and inflammatory markers were undertaken at baseline and throughout the treatment. Results: Thirty-eight patients with active disease were recruited. Thirty-two (84%) patients completed 2 weeks of EEN and had significant improvements in disease symptoms (p = 0.003), serum c-reactive protein (CRP; p = 0.005), insulin-like growth factor-1 (p = 0.006) and faecal calprotectin (FC; p = 0.028). During the following 6 weeks, 21 patients continued EEN (14 [67%] completed treatment) and 11 patients used PEN (9 [82%] completed treatment). Initial improvements in symptoms, CRP and nutrition markers were sustained over the next 6 weeks on both treatments. FC non-significantly increased in 5 out of 9 patients who used PEN and at week 8 FC was greater than 500 µg/g in 9 out of 14 and 7 out of 9 patients who used exclusive or PEN respectively. There was no significant difference in clinical outcomes between the 2 groups at week 8. Conclusion: Two weeks of EEN significantly improved disease symptoms, nutrition and inflammatory markers. Further treatment with exclusive or PEN maintained initial improvements.

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

“…The inability of adults to tolerate EEN's palatability was identified as the primary reason for high rates of nonadherence and withdrawal from trials . Recent studies show promise, with a prospective trial showing that even 2 weeks of EEN in adults with active CD was sufficient to yield significant improvements in symptoms, CRP, and FC . There is evidence that EEN may be more effective in those with newly diagnosed CD and those with ileal disease location; however, further studies are required to substantiate these observations …”

“…Brand‐specific [(Modulen (Nestle Health Science, Epalinges, Switzerland), Osmolite (Abbott Australasia, Macquarie Park NSW, Australia), Paediasure (Abbott Australasia, Macquarie Park NSW, Australia), and Ensure Plus (Abbott Australasia, Macquarie Park NSW, Australia)] and generic EEN formulas have been trialed. Juice‐based polymeric formulas have not been reported . This may be because juice‐based formulas tend to be higher in osmolarity, lower in protein, and lack fat‐soluble vitamins.…”

“…However, most current studies evaluating the efficacy of EEN in CD have not detailed any recommendations for nonprescribed fluid or food intake. Of three studies providing such detail (two pediatric and one adult), one allowed polymeric formula and water only (80.5% complete remission), one allowed additional nonnutritive gums and sweets (85% remission rate), and the adult study allowed tea (remission rate not reported) …”

“…Gradual upgrade of formula over a 2–7‐day period may be required if an elemental formula is used as these are less palatable and can be poorly tolerated. Titration of therapy may also be required in those with problematic vomiting or diarrhea or are at risk of refeeding syndrome …”

Newly Diagnosed Crohn’s Disease Treated with Standard Care or Enteral Nutrition: Psychological Outcomes over 6 Months

“…The EN group has been described elsewhere [22]; in brief, gastroenterologists referred patients for EN therapy who met the following criteria: 16–40 years of age, newly diagnosed with CD involving the small intestine, interested in using EN therapy to treat active disease, and no corticosteroid therapy in the last 2 weeks. Patients received either 8 weeks of EEN or 2 weeks of EEN followed by 6 weeks of EN plus 1 small meal of usual food per day.…”