Comparison of enteral nutrition and drug treatment in active Crohn's disease

Lochs, Herbert; Steinhardt, H. J.; Klaus-Wentz, Berta; Zeitz, Martin; Vogelsang, H.; Sommer, H; Fleig, Wolfgang E.; Bauer, Péter; Schirrmeister, Jörg F.; Malchow, H

doi:10.1016/0016-5085(91)90711-s

Cited by 229 publications

(114 citation statements)

References 19 publications

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“…Peptamen received orally (0.5 mg/kg per day prednisolone) 10 (10) 2 wk Peptide group: CD activity score (CDAS): 5.6 ± 0.8 to 2 ± 1.4 (P < 0.01) ESR: 21.4 ± 6 to 16.7 ± 6.7 (P < 0.05) Permeability index: 4.9 ± 5.3 to 2.1 ± 2 (P < 0.01) BMI: 18.5 ± 3 to 19.2 ± 3.1 (P < 0.02) Prealbumin: 22.2 ± 8 to 23.5 ± 7.8 (P < 0.01) Retinol binding protein: 3.7 ± 0.7 to 4 ± 0.8 (P < 0.02) In vivo cell-mediated immunity (Multitest IMC): 4.2 ± 2.1 to 5.9 ± 2.3 (P < 0.01) (in the corticosteroid group, there were significant findings for improvement of simple CD activity index and fat free mass) [20] Adults with acute active CD…”

Section: Rctmentioning

confidence: 96%

“…Studies of 100% WHP and Crohn's disease are characterized in Table 1 [5,10,11,[13][14][15][16][17][18][19][20][21][22][23][24][25] . In a one year prospective study, six Crohn's disease patients (median age, 13.6 years) were treated with an isotonic, 100% WHP semielemental diet to evaluate growth parameters and disease activity measures [11] .…”

Section: Crohn's Diseasementioning

confidence: 99%

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Nutritional and health benefits of semi-elemental diets: A comprehensive summary of the literature

Alexander¹,

Bylsma²,

Elkayam³

et al. 2016

WJGPT

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AIM:To critically review and summarize the literature on nutritional and health outcomes of semi-elemental formulations on various nutritionally vulnerable patient populations who are unable to achieve adequate nutrition from standard oral diets. METHODS:We conducted a comprehensive literature search of Pubmed and Embase databases. We manually screened articles that examined nutritional and health outcomes (e.g. , growth, disease activity, gastrointestinal impairment, mortality, and economic impact) among various patient groups receiving semi-elemental diets. This review focused on full-text articles of randomized controlled clinical trials and other intervention studies, but pertinent abstracts and case studies were also included. Results pertaining primarily to tolerance, digestion, and absorption were summarized for each patient population in this systematic review.

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Section: Rctmentioning

confidence: 96%

Section: Crohn's Diseasementioning

confidence: 99%

Nutritional and health benefits of semi-elemental diets: A comprehensive summary of the literature

Alexander¹,

Bylsma²,

Elkayam³

et al. 2016

WJGPT

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“…Comparative studies have reported that steroids and sulfasalazine therapy are superior when compared to elemental diets 55,57 . Meta-analyses of randomized controlled trials also favor drug therapy over EN regarding remission of active CD in adults 22,34 .…”

Section: Enteral Nutrition (En)mentioning

confidence: 99%

Inflammatory bowel diseases: principles of nutritional therapy

et al. 2002

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Inflammatory Bowel Diseases - ulcerative colitis and Crohn's disease- are chronic gastrointestinal inflammatory diseases of unknown etiology. Decreased oral intake, malabsorption, accelerated nutrient losses, increased requirements, and drug-nutrient interactions cause nutritional and functional deficiencies that require proper correction by nutritional therapy. The goals of the different forms of nutritional therapy are to correct nutritional disturbances and to modulate inflammatory response, thus influencing disease activity. Total parenteral nutrition has been used to correct and to prevent nutritional disturbances and to promote bowel rest during active disease, mainly in cases of digestive fistulae with high output. Its use should be reserved for patients who cannot tolerate enteral nutrition. Enteral nutrition is effective in inducing clinical remission in adults and promoting growth in children. Due to its low complication rate and lower costs, enteral nutrition should be preferred over total parenteral nutrition whenever possible. Both present equal effectiveness in primary therapy for remission of active Crohn's disease. Nutritional intervention may improve outcome in certain individuals; however, because of the costs and complications of such therapy, careful selection is warranted, especially in patients presumed to need total parenteral nutrition. Recent research has focused on the use of nutrients as primary treatment agents. Immunonutrition is an important therapeutic alternative in the management of inflammatory bowel diseases, modulating the inflammation and changing the eicosanoid synthesis profile. However, beneficial reported effects have yet to be translated into the clinical practice. The real efficacy of these and other nutrients (glutamine, short-chain fatty acids, antioxidants) still need further evaluation through prospective and randomized trials.

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“…83,85,88 In two others, the conclusion that the two treatments were therapeutically equivalent was made only after any individuals who were unable to tolerate the enteral feedings (and who may have had more severe disease) were excluded from the analysis. 82,86 The two largest trials 92,93 found that the steroid therapy was superior to the enteral feeding. Two meta-analyses have also concluded that steroid therapy is superior.…”

Section: In¯ammatory Bowel Diseasementioning

confidence: 99%

Nutritional support

Ofman

Koretz

1997

Aliment Pharmacol Ther

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Nutritional support currently accounts for about 1% of the total health care costs in the USA. Interestingly, most of the prospective randomized controlled trials to date have not been able to demonstrate that this therapeutic intervention alters morbidity or mortality. In fact, parenteral nutritional support may predispose the recipients to developing systemic infections. There have been a few areas in which nutritional support may be of benefit. Enteral supplements given to underweight women who suffer hip fractures reduce the hospital stay and, presumably, overall cost. Preoper‐ative parenteral nutritional support may produce a small absolute reduction in post‐operative morbidity, but its cost becomes prohibitive. Preoperative enteral nutritional support, especially if carried out in the home, may be of benefit (using the most optimistic interpretation of a small number of trials); if so, it is an economically defensible intervention. Particular nutrients or diets may have specific effects on certain disease processes. Indirect comparisons have suggested that elemental diets can be used to treat flares of Crohn's disease (perhaps because putative food antigens are removed). However, corticosteroid therapy is more efficacious. Furthermore, it is less expensive to employ 6‐mercaptopurine as the next modality in steroid failures. Branched‐chain amino acid infusions may have some effect on hepatic encephalopathy, but again, lactulose is less expensive. Nutritional support is one area of medicine in which there has been far more enthusiasm than the data justify. Disease‐associated malnutrition probably is a secondary phenomenon, not an important cause of morbidity. The widespread use of this modality cannot be justified in a cost‐constrained health care system.

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Comparison of enteral nutrition and drug treatment in active Crohn's disease

Cited by 229 publications

References 19 publications

Nutritional and health benefits of semi-elemental diets: A comprehensive summary of the literature

Nutritional and health benefits of semi-elemental diets: A comprehensive summary of the literature

Inflammatory bowel diseases: principles of nutritional therapy

Nutritional support

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