Intest Res.  2019 Apr;17(2):171-176. 10.5217/ir.2018.00079.

An overview of the role of exclusive enteral nutrition for complicated Crohn's disease

• Adamji M
• Day AS

• KMID: 2449958
• DOI: http://doi.org/10.5217/ir.2018.00079

Abstract

The role and efficacy of exclusive enteral nutrition (EEN) in the treatment of luminal Crohn's disease (CD) has been well established over the last 2 decades. Consequently, in many centers nutritional therapy is now considered first line therapy in the induction of remission of active CD. However, the use of nutritional therapy in complicated CD has yet to be fully determined. This article aimed to review case reports and clinical trials published in the last decade that have considered and evaluated nutritional therapy in the setting of complicated CD in children and adults. Published literature focusing upon the use of nutritional therapy as part of medical therapy in the management of complicated CD were identified and reviewed. Although there continue to be various interventions utilized for complicated CD, the currently available literature demonstrates that nutritional therapies, especially EEN, have important roles in the management of these complex scenarios. Further assessments, involving large numbers of patients managed with consistent approaches, are required to further substantiate these roles.

Keyword

Child; Crohn disease; Intestinal fistula; Intestinal obstruction; Nutrition

MeSH Terms

Adult
Child
Crohn Disease*
Enteral Nutrition*
Humans
Intestinal Fistula
Intestinal Obstruction
Phenobarbital
Remission Induction
Phenobarbital

Reference

1. Lemberg DA, Day AS. Crohn disease and ulcerative colitis in children: an update for 2014. J Paediatr Child Health. 2015; 51:266–270.

2. Van Limbergen J, Russell RK, Drummond HE, et al. Definition of phenotypic characteristics of childhood-onset inflammatory bowel disease. Gastroenterology. 2008; 135:1114–1122.

3. Critch J, Day AS, Otley A, et al. Use of enteral nutrition for the control of intestinal inflammation in pediatric Crohn disease. J Pediatr Gastroenterol Nutr. 2012; 54:298–305.

4. Wall CL, Day AS, Gearry RB. Use of exclusive enteral nutrition in adults with Crohn’s disease: a review. World J Gastroenterol. 2013; 19:7652–7660.

5. Day AS, Lopez RN. Exclusive enteral nutrition in children with Crohn’s disease. World J Gastroenterol. 2015; 21:6809–6816.

6. Ruemmele FM, Veres G, Kolho KL, et al. Consensus guidelines of ECCO/ESPGHAN on the medical management of pediatric Crohn’s disease. J Crohns Colitis. 2014; 8:1179–1207.

7. Lochs H, Dejong C, Hammarqvist F, et al. ESPEN guidelines on enteral nutrition: gastroenterology. Clin Nutr. 2006; 25:260–274.

8. Management of inflammatory bowel disease in children and adolescents in New Zealand: a clinical guideline. Starship Web site. https://www.starship.org.nz/for-health-professionals/new-zealand-child-and-youth-clinical-networks/child-and-youth-clinical-network-for-gastroenterology-services/management-of-inflammatory-bowel-disease. Accessed April 16, 2018.

9. Heuschkel RB, Menache CC, Megerian JT, Baird AE. Enteral nutrition and corticosteroids in the treatment of acute Crohn’s disease in children. J Pediatr Gastroenterol Nutr. 2000; 31:8–15.

10. Grover Z, Muir R, Lewindon P. Exclusive enteral nutrition induces early clinical, mucosal and transmural remission in paediatric Crohn’s disease. J Gastroenterol. 2014; 49:638–645.

11. Navas-López VM, Blasco-Alonso J, Lacasa Maseri S, et al. Exclusive enteral nutrition continues to be first line therapy for pediatric Crohn’s disease in the era of biologics. An Pediatr (Barc). 2015; 83:47–54.

12. de Bie C, Kindermann A, Escher J. Use of exclusive enteral nutrition in paediatric Crohn’s disease in The Netherlands. J Crohns Colitis. 2013; 7:263–270.

13. Afzal NA, Davies S, Paintin M, et al. Colonic Crohn’s disease in children does not respond well to treatment with enteral nutrition if the ileum is not involved. Dig Dis Sci. 2005; 50:1471–1475.

14. Buchanan E, Gaunt WW, Cardigan T, Garrick V, McGrogan P, Russell RK. The use of exclusive enteral nutrition for induction of remission in children with Crohn’s disease demonstrates that disease phenotype does not influence clinical remission. Aliment Pharmacol Ther. 2009; 30:501–507.

15. Zachos M, Tondeur M, Griffiths AM. Enteral nutritional therapy for induction of remission in Crohn’s disease. Cochrane Database Syst Rev. 2007; (1):CD000542.

16. Heuschkel R. Enteral nutrition should be used to induce remission in childhood Crohn’s disease. Dig Dis. 2009; 27:297–305.

17. Kaakoush NO, Day AS, Leach ST, Lemberg DA, Nielsen S, Mitchell HM. Effect of exclusive enteral nutrition on the microbiota of children with newly diagnosed Crohn’s disease. Clin Transl Gastroenterol. 2015; 6:e71.

18. Lewis JD, Chen EZ, Baldassano RN, et al. Inflammation, antibiotics, and diet as environmental stressors of the gut microbiome in pediatric Crohn’s disease. Cell Host Microbe. 2015; 18:489–500.

19. Fell JM, Paintin M, Arnaud-Battandier F, et al. Mucosal healing and a fall in mucosal pro-inflammatory cytokine mRNA induced by a specific oral polymeric diet in paediatric Crohn’s disease. Aliment Pharmacol Ther. 2000; 14:281–289.

20. de Jong NS, Leach ST, Day AS. Polymeric formula has direct anti-inflammatory effects on enterocytes in an in vitro model of intestinal inflammation. Dig Dis Sci. 2007; 52:2029–2036.

21. Nahidi L, Day AS, Lemberg DA, Leach ST. Differential effects of nutritional and non-nutritional therapies on intestinal barrier function in an in vitro model. J Gastroenterol. 2012; 47:107–117.

22. Gerasimidis K, Talwar D, Duncan A, et al. Impact of exclusive enteral nutrition on body composition and circulating micronutrients in plasma and erythrocytes of children with active Crohn’s disease. Inflamm Bowel Dis. 2012; 18:1672–1681.

23. Sidler MA, Lemberg DA, Day AS. Combination of nutritional therapy and medical therapy for the management of enterovesical fistula in paediatric Crohn’s disease: a case report. Clin Nutr ESPEN. 2008; 3:e89–e91.

24. Wong S, Lemberg DA, Day AS. Exclusive enteral nutrition in the management of perianal Crohn’s disease in children. J Dig Dis. 2010; 11:185–188.

25. Yang Q, Gao X, Chen H, et al. Efficacy of exclusive enteral nutrition in complicated Crohn’s disease. Scand J Gastroenterol. 2017; 52:995–1001.

26. Yan D, Ren J, Wang G, Liu S, Li J. Predictors of response to enteral nutrition in abdominal enterocutaneous fistula patients with Crohn’s disease. Eur J Clin Nutr. 2014; 68:959–963.

27. Day AS, Brown SC. The adjunctive role of nutritional therapy in the management of phlegmon in two children with Crohn’s disease. Front Pediatr. 2017; 5:199.

28. Hu D, Ren J, Wang G, et al. Exclusive enteral nutritional therapy can relieve inflammatory bowel stricture in Crohn’s disease. J Clin Gastroenterol. 2014; 48:790–795.

29. Heerasing N, Thompson B, Hendy P, et al. Exclusive enteral nutrition provides an effective bridge to safer interval elective surgery for adults with Crohn’s disease. Aliment Pharmacol Ther. 2017; 45:660–669.

30. Kim HJ, Kim Y, Cho JM, Oh SH, Kim KM. Therapeutic efficacy of oral enteral nutrition in pediatric Crohn’s disease: a single center non-comparative retrospective study. Yonsei Med J. 2016; 57:1185–1191.

31. Xie Y, Zhu WM, Li N, Li JS. Enteral nutritional therapy in Crohn disease complicated with incomplete intestinal obstruction. Zhonghua Wei Chang Wai Ke Za Zhi. 2010; 13:891–894.

32. Yamamoto T, Nakahigashi M, Umegae S, Kitagawa T, Matsumoto K. Acute duodenal Crohn’s disease successfully managed with low-speed elemental diet infusion via nasogastric tube: a case report. World J Gastroenterol. 2006; 12:649–651.

33. Cameron EA, Middleton SJ. Elemental diet in the treatment of orofacial Crohn’s disease. Gut. 2003; 52:143.

34. Mutalib M, Bezanti K, Elawad M, Kiparissi F. The role of exclusive enteral nutrition in the management of orofacial granulomatosis in children. World J Pediatr. 2016; 12:421–424.