Abstract
Malnutrition is a common consequence of inflammatory bowel disease (IBD). Diet has an important role in the management of IBD, as it prevents and corrects malnutrition. It is well known that diet may be implicated in the aetiology of IBD and that it plays a central role in the pathogenesis of gastrointestinal-tract disease. Often oral nutrition alone is not sufficient in the management of IBD patients, especially in children or the elderly, and must be combined with oral supplementation or replaced with tube enteral nutrition. In this review, we describe several different approaches to enteral nutrition—total parenteral, oral supplementation and enteral tube feeding—in terms of results, patients compliance, risks and and benefits. We also focus on the home entaral nutrition strategy as the future goal for treating IBD while focusing on patient wellness.
Highlights
Enteral nutritional therapy aims to maintain or restore the nutritional status of individuals who fail to maintain a sufficient oral intake, despite having a fully or partially functioning gastrointestinal tract
The use of total parenteral nutrition (TPN) in the management of active Crohn’s disease (CD) is based on theoretical advantages including bowel rest, which could reduce the motor and transport functions of the diseased bowel; reduction of antigenic stimulation, which could eliminate the immunological response to food favored by the presence of impaired intestinal permeability; and stimulation of protein synthesis, which could lead to cell renewal and mucosal healing in the intestine [13]
Enteral nutrition should be used as primary therapy in CD for a number of reasons
Summary
Enteral nutritional therapy aims to maintain or restore the nutritional status of individuals who fail to maintain a sufficient oral intake, despite having a fully or partially functioning gastrointestinal tract. It is possible that some nutrients act either as antigens or have therapeutic effects in the intestinal mucosa [2] In both UC and CD, nutritional deficiencies of various severities are often found. Malnutrition in IBD depends on several factors such as inflammatory processes, impaired intestinal absorption, nutrients loss through the inflamed and ulcerated gut, bacterial overgrowth, medical management with steroids or imposed dietary restrictions [2,5]. These observations suggest that nutritional support may be the best approach to treat IBD instead of using drugs, as it could control inflammation and treat malnutrition without side effects. One of the most important goals of nutritional therapy should be to prevent and treat undernutrition, improving the growth and development of children and adolescents using total parenteral nutrition (TPN), enteral nutrition (EN), or by correcting micronutrient deficiency [8,9]
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