Enteral Nutrition in Adult Crohn’s Disease: Toward a Paradigm Shift

Di Caro Di Caro,Rahman Rahman,Fragkos Fragkos,Mehta Mehta,Keetarut Keetarut,Barragry Barragry,Saravanapavan Saravanapavan,Sebepos-Rogers Sebepos-Rogers,Koo Koo,Rogers Rogers

doi:10.3390/nu11092222

Di Caro Di Caro, Rahman Rahman + Show 8 more

Open Access

https://doi.org/10.3390/nu11092222

Copy DOI

Abstract

Medical and surgical treatments for Crohn’s disease are associated with toxic effects. Medical therapy aims for mucosal healing and is achievable with biologics, immunosuppressive therapy, and specialised enteral nutrition, but not with corticosteroids. Sustained remission remains a therapeutic challenge. Enteral nutrition, containing macro- and micro-nutrients, is nutritionally complete, and is provided in powder or liquid form. Enteral nutrition is a low-risk and minimally invasive therapy. It is well-established and recommended as first line induction therapy in paediatric Crohn’s disease with remission rates of up to 80%. Other than in Japan, enteral nutrition is not routinely used in the adult population among Western countries, mainly due to unpalatable formulations which lead to poor compliance. This study aims to offer a comprehensive review of available enteral nutrition formulations and the literature supporting the use and mechanisms of action of enteral nutrition in adult Crohn’s disease patients, in order to support clinicians in real world decision-making when offering/accepting treatment. The mechanisms of actions of enteral feed, including their impact on the gut microbiome, were explored. Barriers to the use of enteral nutrition, such as compliance and the route of administration, were considered. All available enteral preparations have been comprehensively described as a practical guide for clinical use. Likewise, guidelines are reported and discussed.

Highlights

IntroductionUp to a third of patients are diagnosed during adolescence, leading to many years of disease and associated morbidity
About 115,000 people in the UK have Crohn’s disease (CD) [1,2]
This study aims to offer a comprehensive review of available Enteral nutrition (EN) formulations and the literature supporting the use and mechanisms of action of EN in adult CD patients, to support clinicians and patients in real world decision-making when offering/accepting treatment

Summary

Introduction

Up to a third of patients are diagnosed during adolescence, leading to many years of disease and associated morbidity Half of these patients will require surgery during the natural history of their disease, and more than 75% of those will undergo further surgery [3,4,5]. Complications such as stricturing or penetrating disease with fistulae and abscess formation occur in a significant proportion of patients. Genetic and environmental factors affect CD phenotypes [6,7]. CD phenotypes in childhood are more aggressive than when the disease arises in adulthood [6,7]

Objectives

Methods

Results

Conclusion