P551 Use of preoperative total parenteral nutrition is associated with clinical and laboratory remission in severe active Crohn’s disease

Abstract

Crohn’s disease (CD) patients with active penetrating and stricturing disease have a high prevalence of malnutrition that has been shown to increase post-operative complications. The effect of 1–3 months of pre-operative exclusive total parental nutrition (TPN) in active CD patients is not well established. We investigated the efficacy of exclusive TPN in active CD patients. From our IBD Centre database (prospectively collected data) we identified all patients with complicated, active CD who were candidates for bowel resection between January 2016 and October 2018. CD location and activity were recorded based on the modified Montreal classification. Inclusion required exclusive preoperative home TPN without additional oral intake for the 1–3 months prior to surgery. The Harvey–Bradshaw Index (HBI), body mass index (BMI), C-reactive protein (CRP) and albumin levels were recorded at baseline and at the end of TPN therapy. Seventeen pre-operative CD patients (58.8% male, 41.2% female) on exclusive TPN were identified. The mean age of the cohort was 31.5 ± 11.8 years with median disease duration of 8 years (IQR 3–12). Mean duration of pre-operative TPN treatment was 69 days (range 24–110). Most patients had ileocolonic (35.3%) or terminal ileal CD (23.5%), and the stricturing and/or stenotic (B2) phenotype (94.1%) was the most common. During TPN treatment, 70.6% were on stable doses of medication (immunomodulators and/or biologics) and 29.4% had no medical treatment. All 17 patients had significant clinical improvement in all disease activity indices at the end of preoperative TPN (baseline vs. post TPN): HBI 16.3 ± 7 vs. 6.1 ± 6.1 (p = 0.001); BMI 19.7 ± 3.3 vs. 20.8 ± 3.2 (p = 0.017); CRP 58.5 (IQR 33–149) vs. 12.5 (IQR 6–30) (p = 0.001); and albumin 2.8 ± 0.6 vs. 3.7 ± 0.5 (p = 0.001). Two patients (11.7%) no longer required bowel resections after completion of exclusive TPN. Exclusive pre-operative TPN was associated with weight gain, decreased inflammatory biomarkers, and improved clinical disease activity markers and nutrition. While these initial results are encouraging, additional studies are needed before a recommendation can be made regarding longer duration of exclusive pre-operative TPN for severe, refractory CD to decrease disease activity and improve nutritional status before elective surgery.