Intest Res.  2021 Jul;19(3):291-300. 10.5217/ir.2019.09172.

Efficacy and tolerability of exclusive enteral nutrition in adult patients with complicated Crohn’s disease

• Sharma S
• Gupta A
• Kedia S
• Agarwal S
• Singh N
• Goyal S
• Jain S
• Gupta V
• Sahu P
• Vuyyuru SK
• Kante B
• Sharma R
• Panwar R
• Sahni P
• Makharia G
• Ahuja V

• KMID: 2518685
• DOI: http://doi.org/10.5217/ir.2019.09172

Abstract

Background/Aims
Exclusive enteral nutrition (EEN), an established modality for pediatric Crohn’s disease (CD) is seldomly utilized in adults. The present study reports the outcome of EEN in adult CD patients at a tertiary care hospital in India.
Methods
This was a retrospective analysis of CD patients who received EEN as a sole modality/adjunct to other treatment. The primary and secondary outcomes changed in Crohn’s Disease Activity Index (CDAI), and clinical response (decline in CDAI > 70), respectively, at 4 and 8 weeks. Subgroup analysis evaluated response across different phenotypes, EEN formulations and prior treatment. Linear mixed effect model was created to assess the predictors of EEN response.
Results
Thirty-one CD patients received EEN over median duration of 4 weeks (range, 2–6 weeks). CDAI showed a significant improvement post EEN at 4 (baseline 290 [260–320] vs. 240 [180–280], P= 0.001) and 8 weeks (baseline 290 [260–320] vs. 186 [160–240], P= 0.001), respectively. The cumulative clinical response rates at 4 and 8 weeks were 37.3% and 80.4% respectively. The clinical response rates at 8 weeks across B1 (n = 4), B2 (n = 18) and B3 (n = 9) phenotypes were 50%, 78.8% and 100% respectively (log-rank test, P= 0.093). The response rates at 8 weeks with polymeric (n = 8) and semi-elemental diet (n = 23) were 75% and 82.6%% respectively (log-rank test, P= 0.49). Baseline CDAI (odds ratio, 1.008; 95% confidence interval, 1.002–1.017; P= 0.046) predicted response to EEN.
Conclusions
EEN was effective in inducing clinical response across different phenotypes of CD. Baseline disease activity remained the most important predictor of clinical response to EEN.

Keyword

Exclusive enteral nutrition; Crohn disease; Crohn’s Disease Activity Index; Inflammation

Figure

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  Fig. 1. Flowchart of the patient recruitment in the study. CD, Crohn’s disease; EEN, exclusive enteral nutrition; GI, gastrointestinal.

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  Fig. 2. Profile plots depicting change in Crohn’s Disease Activity Index (CDAI) (A), hemoglobin (B), and serum albumin (C) levels with exclusive enteral nutrition administration across different phenotypes of Crohn’s disease assessed at 4 and 8 weeks respectively.

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  Fig. 3. Kaplan-Meier response plot showing clinical response to exclusive enteral nutrition (EEN). The cumulative clinical response rates to EEN at 4 and 8 weeks were 37.3% and 80.4% respectively.

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  Fig. 4. Kaplan-Meier response plot showing clinical response across different phenotypes of disease. The clinical response rates at 8 weeks in B1 (n=4), B2 (n=18), and B3 (n=9) disease were 50%, 78.8%, and 100% respectively (log-rank test, P=0.093).

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