Enteral Nutrition Associated with Decreased Risk of Postoperative Recurrence of Crohnʼs Disease

Abstract

Introduction: Crohn's disease (CD) is a chronic, relapsing-remitting disorder of the gastrointestinal tract. CD patients often undergo surgical resection for treatment of their disease, though are still at risk of postoperative recurrence. Enteral nutrition (EN) is frequently used in CD as adjunct to medical therapy to manage protein-calorie malnutrition. It has also been suggested that EN may help both induce and maintain remission and promote mucosal healing. While several studies have shown decreased rates of postoperative CD recurrence following EN treatment, this association has not been well established. Objective: Assess effect of EN on postoperative clinical and endoscopic recurrence in Crohn's disease patients. Methods: A thorough search of multiple databases, including Scopus, Cochrane, MEDLINE/PubMed, and CINAHL were performed (May 2018). Studies assessing the role of pre- or postoperative enteral nutrition in preventing postoperative clinical and endoscopic recurrence of CD were included. A metaanalysis was completed using the Mantel-Haenszel model. Results: In a complete analysis of five studies, there was a 5-fold decrease risk in developing clinical recurrence at one year (OR 5.04 95% CI 2.66, 9.952, p2=80%). Sensitivity analysis excluded one study with lowest rate of recurrence in non-EN group to minimize heterogeneity there remains a dramatic decrease in clinical recurrence among patients on EN relative to no EN (OR 16.68 95% CI 6.37,43.66 p2=0%). Similar results were noted for clinical recurrence with EN at 5 year postoperatively with decreased risk for recurrence more than 24-fold in the group receiving EN compared to no EN (OR 24.61 95% CI 11.52,52.57 p2=78%). Two studies, by Wang, et al, and Yamamoto, et al, also assessed for endoscopic recurrence. Risk of endoscopic recurrence at 1 year was decreased by nearly 3-fold in the EN group relative to no EN (OR 2.69 95% CI 1.22,5.92 p=0.01, I2=48%) with EN. Conclusion: Postoperative enteral nutrition is associated with decreased rates of clinical and endoscopic recurrence after surgical resection. Further studies are needed to assess optimal duration of EN and longer-term effects.