Abstract
Genetic and environmental factors are thought to profoundly influence the pathophysiology of Crohn’s disease (CD). Changes in dietary and hygiene patterns affect the interactions between the immune system and environment. The gut microbiome is responsible for mediating host immune response with significant dysbiosis observed in individuals with CD. Diet therapy using exclusive enteral nutrition (EEN) has been studied as primary therapy for the management of CD. EEN may cultivate the presence of beneficial microbiota, improve bile acid metabolism, and decrease the number of dietary microparticles possibly influencing disease and immune activity. In this review, we will address the current evidence on EEN in the management of adult and pediatric CD. In adults, EEN appears to be moderately beneficial for the induction of remission of CD; however, its use is understudied and underutilized. Stronger evidence is in place to support the use of EEN in pediatric CD with the added benefit of nutrition support and steroid-sparing therapy during the growth phase. Overall, EEN is an established therapy in inducing CD remission in the pediatric population while its role as primary therapy of adult Crohn’s disease remains to be defined.
Highlights
Crohn’s disease (CD) is an incurable chronic inflammatory condition of the gastrointestinal tract.The goals of therapy are to attain histologic and clinical remission through the complementary use of pharmacologic, nutritional, and surgical therapies [1]
In the 1970s, Voitk et al were the first to report on the value of enteral nutrition (EN) in the management of active inflammatory bowel disease (IBD)
Information regarding enteral nutrition in the management of malnutrition and micronutrient deficiencies in CD will not be included in this review
Summary
Crohn’s disease (CD) is an incurable chronic inflammatory condition of the gastrointestinal tract. In the 1970s, Voitk et al were the first to report on the value of enteral nutrition (EN) in the management of active inflammatory bowel disease (IBD). After providing their patients with EN for 3 weeks, they noted improved inflammatory indices and nutritional states leading them to postulate whether EN could be a primary therapy [2]. We will provide a synopsis of EN formulations, discuss the possible mechanisms of exclusive enteral nutrition (EEN) action and evaluate the current evidence on EN in the management. Information regarding enteral nutrition in the management of malnutrition and micronutrient deficiencies in CD will not be included in this review
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