Preoperative Exclusive Total Parental Nutrition is Associated with Clinical and Laboratory Remission in Severe Active Crohn's Disease-A Pilot Study.

Eran Zittan,Nasser Sakran,Ian M Gralnek,Ossama A Hatoum,Nitzan Kolonimos

doi:10.3390/nu12051244

Eran Zittan, Nasser Sakran + Show 3 more

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https://doi.org/10.3390/nu12051244

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Abstract

Background: The effect of 1–3 months of preoperative exclusive total parental nutrition (TPN) in active Crohn’s disease (CD) patients is not well established. We investigated the efficacy of exclusive TPN in active CD patients. Methods: In a retrospective multi-visit study with data according to our standard care therapy, we assessed clinical and laboratory remission to refractory CD with exclusive preoperative TPN. Inclusion required exclusive preoperative home TPN without additional oral intake for 1–3 months prior to planning surgery. Results: Twenty preoperative CD patients (65% male; 35% female) were on exclusive TPN. The mean age of the cohort was 30.8 ± 11.6 years. Mean duration of preoperative TPN treatment was 73 days (range: 24–142 days). Most patients had terminal ileal (35%) or ileocolonic CD (30%), and with stricturing (B2) phenotype. All 20 patients had significant clinical improvement in all disease activity indices at the end of preoperative TPN (baseline vs. post TPN): HBI 14.5 vs. 4.0 (p = 0.001); BMI 19.2 vs. 19.7 kg/m2 (p = 0.017); CRP 57.2 vs. 10.3 mg/L (p = 0.001); Fecal calprotectin (FC) 672 vs. 200 (μg/g); albumin 2.7 vs. 3.6 g/dL (p = 0.001). Two patients (10%) no longer required surgery after completion of exclusive TPN. Conclusion: Exclusive preoperative TPN was found to provide significant improvement in nutritional status, and clinical and laboratory remission in severe active Crohn’s patients.

Highlights

Crohn’s disease (CD) is a chronic relapsing and remitting autoimmune disease marked by transmural inflammation that most commonly affects the small and large intestines
One patient had CD localized to the colon, while another patient had a combination of colonic CD with small intestinal involvement distal to the ligament of Treitz excluding the terminal ileum (Table 1)
Preoperative exclusive total parental nutrition (TPN) was found to lead to statistically significant weight gain, decreased inflammatory biomarkers (FC, C-reactive protein (CRP)) and improved clinical disease activity and nutrition

Summary

Introduction

Crohn’s disease (CD) is a chronic relapsing and remitting autoimmune disease marked by transmural inflammation that most commonly affects the small and large intestines. Postoperative complications occur in approximately 30% of CD patients undergoing intestinal surgery, leading to an increased burden for patients, physicians, and health care systems [12,13]. There are limited data to support the use of “exclusive” preoperative total parental nutrition (TPN). The purpose of this pilot study is to assess the efficacy of exclusive TPN on nutritional optimization prior to intestinal surgery in a CD cohort that failed medical management. The effect of 1–3 months of preoperative exclusive total parental nutrition (TPN) in active Crohn’s disease (CD) patients is not well established. Inclusion required exclusive preoperative home TPN without additional oral intake for 1–3 months prior to planning surgery. The mean age of the cohort was 30.8 ± 11.6 years

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Results

Conclusion