Use of exclusive enteral nutrition in adults with Crohn’s disease: A review

Abstract

Exclusive enteral nutrition (EEN) is well-established as a first line therapy instead of corticosteroid (CS) therapy to treat active Crohn's disease (CD) in children. It also has been shown to have benefits over and above induction of disease remission in paediatric populations. However, other than in Japanese populations, this intervention is not routinely utilised in adults. To investigate potential reasons for variation in response between adult studies of EEN and CS therapy. The Ovid database was searched over a 6-mo period. Articles directly comparing EEN and CS therapy in adults were included. Eleven articles were identified. EEN therapy remission rates varied considerably. Poor compliance with EEN therapy due to unpalatable formula was an issue in half of the studies. Remission rates of studies that only included patients with previously untreated/new CD were higher than studies including patients with both existing and new disease. There was limited evidence to determine if disease location, duration of disease or age of diagnosis affected EEN therapy outcomes. There is some evidence to support the use of EEN as a treatment option for a select group of adults, namely those motivated to adhere to an EEN regimen and possibly those newly diagnosed with CD. In addition, the use of more palatable formulas could improve treatment compliance.

Preoperative Enteral Nutrition and Surgical Outcomes in Adults with Crohn’s Disease: A Systematic Review

“…In the West, the administration of nutritional support by means of a nasogastric tube is poorly accepted by adults [24]. However, tolerance and acceptance towards the oral route has grown with improvements in the quality and variety of flavors of the polymeric formulations [24, 27]. …”

“…In this age group, the therapeutic value of EN in CD is controversial outside the bounds of malnutrition. It may therefore be advised as remission-inducing therapy in case of refusal or intolerance to CSTs, in mild extensive small bowel disease (here as primary or as adjuvant therapy), and as adjuvant therapy in the undernourished which maintain inflammatory stenosis, despite maximized adequate pharmacological therapy [24, 27-29]. The grade of evidence concerning the superiority of CSTs over EEN in adult patients is, however, of very low quality [24].…”

Dietary Approach to Ulcerative Colitis Disease: Up to Date: Review

“…Özellikle elemental formülaların İBH hastalarında olumlu sonuçları olduğu belirtilmektedir. 36 Tedavinin temelinde, hastaları remisyon döneminde tutmayı kolaylaştırdığı, relaps sıklığını azalttığı, mukozal iyileştirmeyi kolaylaştırdığı ve hastanede kalış sü-resini kısalttığı bildirilmektedir. 23 Ancak, aktif dö-nemdeki ülseratif kolit hastalarında enteral beslenmenin efektif olmadığı vurgulanmaktadır.…”

Advances in Nutrition of Patients with Inflammatory Bowel Diseases

“…Moreover, benefits of this kind of therapy in UC have not been explicitly demonstrated. Rare studies on the role of nutrition in UC exacerbations indicate no distinct differences in the impact on the remission index or need of colostomy between enteral and parenteral nutrition in patients treated with steroids [83]. Enteral feeding in UC exacerbations shows anabolic action, is safe and justified when the nutritional status has to be improved and deficiencies corrected.…”