Article

Impact of long-term enteral nutrition on clinical and endoscopic recurrence after resection for Crohn's disease: A prospective, non-randomized, parallel, controlled study

Inflammatory Bowel Disease Centre & Department of Surgery, Yokkaichi Social Insurance Hospital, Yokkaichi, Mie, Japan.
Alimentary Pharmacology & Therapeutics (Impact Factor: 5.73). 02/2007; 25(1):67-72. DOI: 10.1111/j.1365-2036.2006.03158.x
Source: PubMed

ABSTRACT

The impact of enteral nutrition on post-operative recurrence has not been properly examined.
To investigate the impact of enteral nutrition using an elemental diet on clinical and endoscopic recurrence after resection for Crohn's disease.
Forty consecutive patients who underwent resection for ileal or ileocolonic Crohn's disease were studied. After operation, 20 patients continuously received enteral nutritional therapy (EN group), and 20 had neither nutritional therapy nor food restriction (non-EN group). In the EN group, enteral formula (Elental) was infused through a nasogastric tube in the night-time, and low fat foods were taken in the daytime. All patients were followed up regularly for 1 year after operation. Ileocolonoscopy was performed at 6 and 12 months after operation.
One patient (5%) in the EN group and seven (35%) in the non-EN group developed clinical recurrence during 1-year follow-up (P = 0.048). Six months after operation, five patients (25%) in the EN group and eight (40%) in the non-EN group developed endoscopic recurrence (P = 0.50). Twelve months after operation, endoscopic recurrence was observed in six patients (30%) in the EN group and 14 (70%) in the non-EN group (P = 0.027).
Our long-term enteral nutritional therapy significantly reduced clinical and endoscopic recurrence after resection for Crohn's disease.

Download full-text

Full-text

Available from: Takayuki Yamamoto, May 28, 2014
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The majority of patients with Crohn’s disease require surgery for disease-related complications. Postoperative Crohn’s disease recurrence is common after intestinal resection. The optimal management strategy for postoperative recurrence of Crohn’s disease is controversial. In the absence of universally adopted guidelines, clinicians and patients must discuss and weigh the risks and benefits of postoperative pharmacotherapy. Those patients at low risk of disease recurrence may not require treatment. On the other hand, patients with more aggressive disease and high risk of recurrence may be best treated early in the postoperative period with an immunomodulator or antitumor necrosis factor agents. Ideally, postoperative treatment decisions would be made using predictable, reliable, and reproducible clinical prediction criteria that would guide treatment. This article reviews the data on postoperative Crohn’s disease, including predictors of early recurrence, available options for postoperative monitoring, timing of initiation, and choice of postoperative therapy for prevention and management.
    Preview · Article · Aug 2009
  • [Show abstract] [Hide abstract]
    ABSTRACT: Each of the medical and surgical therapies for Crohn’s disease has inherent advantages and disadvantages that must be balanced for patients with moderate to severe disease. Most patients with Crohn’s disease require surgery at some point during the lifelong illness, but surgical therapy is not curative for most patients, as postoperative recurrence of Crohn’s disease is common and can pose diagnostic and therapeutic challenges. Disease monitoring and appropriate prophylaxis are necessary in patients at high risk.
    No preview · Article · Dec 2008 · Current Gastroenterology Reports
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Long-term enteral nutrition may maintain clinical and endoscopic remission in patients with Crohn's disease (CD). The aim of this prospective study was to investigate the impacts of long-term enteral nutrition on clinical and endoscopic disease activities and mucosal tissue cytokines in patients with quiescent CD. Forty patients with CD who achieved clinical remission were included. Of these, 20 received continuous elemental diet (Elental) infusion during the nighttime and a low-fat diet during the daytime (EN group) and 20 received neither nutritional therapy nor food restriction (non-EN group). With these regimens, all 40 patients were monitored for 1 year. Further, ileocolonoscopy was performed at entry, at 6 and 12 months, and mucosal biopsies were taken for cytokine assays. On an intention-to-treat basis, 5 patients (25%) in the EN group and 13 (65%) in the non-EN group had a clinical relapse during the 1-year observation (P = 0.03). The mean endoscopic inflammation (EI) scores were not significantly different between the groups at both entry and 6 months, but at 12 months EI scores were significantly higher in the non-EN group than in the EN group (P = 0.04). Additionally, the mucosal tissue interleukin (IL)-1beta, IL-6, and tumor necrosis factor (TNF)-alpha levels significantly increased with time in the non-EN group (entry versus 12 months, IL-1beta, P = 0.02; IL-6, P = 0.002; TNF-alpha, P = 0.001). In the EN group these cytokines did not show a significant increase. Long-term enteral nutrition in patients with quiescent CD has a clear suppressive effect on clinical and endoscopic disease activities and the mucosal inflammatory cytokine levels.
    Full-text · Article · Dec 2007 · Inflammatory Bowel Diseases
Show more