Enteral nutrition in the management of Crohn's disease.

Exclusive feeding of defined formula diets has been used successfully as an alternative to corticosteroid treatment of active Crohn's disease, but the mechanism of efficacy remains conjectural. Recognition that polymorphisms in the NOD2/CARD15 gene confer susceptibility to Crohn's disease has increased appreciation of the interactions between the innate immune system and enteric bacteria, which lead to chronic intestinal inflammation. The 2 major goals of this workshop are: first, in light of current understanding of pathogenesis, to examine possible mechanisms of action of enteral nutrition as primary therapy; and second, to make evidence-based recommendations concerning its use in the new era of biologic therapies, when mucosal healing has become a realistic goal. Factors influencing efficacy, including duration, location of intestinal inflammation, and formula composition require consideration.