Robert Heuschkel1. 1. Department of Paediatric Gastroenterology, Hepatology and Nutrition, Addenbrookes Hospital, Cambridge University Hospital, Cambridge CB2 0QQ, UK. robert.heuschkel@addenbrookes.nhs.uk
Abstract
BACKGROUND: Exclusive enteral nutrition has been used over many years as a therapy to try and achieve a remission in adults and children presenting with acute Crohn's disease. Despite its reported efficacy at achieving clinical responses in excess of 80% in some case series, it has not been taken up widely as a first-line therapy. This is, at least in part, due to the lack of a large prospective randomised study. METHODS: The literature is replete with small case series and anecdotal reports from units who use this therapy. Recent literature is reviewed on efficacy, application, composition and potential mechanisms of action of this therapy. RESULTS: Although the evidence base remains quite limited, further data are available that suggest a clear benefit of exclusive enteral nutrition as an efficacious alternative to steroid therapy at inducing a clinical remission in Crohn's disease. Certain sub-groups are likely to benefit more, with potential benefits on growth making it particularly useful in adolescents and growing young adults. Given the lack of side effects compared to the alternative of steroid therapy, along with the clear nutritional benefits of this therapy, it remains an obvious choice for patients presenting with Crohn's disease and a degree of malnutrition. CONCLUSIONS: This therapy should remain a first-line therapy for children and adults presenting with mild to moderate Crohn's disease. Copyright 2009 S. Karger AG, Basel.
BACKGROUND: Exclusive enteral nutrition has been used over many years as a therapy to try and achieve a remission in adults and children presenting with acute Crohn's disease. Despite its reported efficacy at achieving clinical responses in excess of 80% in some case series, it has not been taken up widely as a first-line therapy. This is, at least in part, due to the lack of a large prospective randomised study. METHODS: The literature is replete with small case series and anecdotal reports from units who use this therapy. Recent literature is reviewed on efficacy, application, composition and potential mechanisms of action of this therapy. RESULTS: Although the evidence base remains quite limited, further data are available that suggest a clear benefit of exclusive enteral nutrition as an efficacious alternative to steroid therapy at inducing a clinical remission in Crohn's disease. Certain sub-groups are likely to benefit more, with potential benefits on growth making it particularly useful in adolescents and growing young adults. Given the lack of side effects compared to the alternative of steroid therapy, along with the clear nutritional benefits of this therapy, it remains an obvious choice for patients presenting with Crohn's disease and a degree of malnutrition. CONCLUSIONS: This therapy should remain a first-line therapy for children and adults presenting with mild to moderate Crohn's disease. Copyright 2009 S. Karger AG, Basel.