Controlled trial comparing two types of enteral nutrition in treatment of active Crohn's disease: elemental versus polymeric diet.

Rigaud, Daniel; Cosnes, Jacques; Quintrec, Y Le; René, E; Jp, Gendre; Mignon, M

doi:10.1136/gut.32.12.1492

Cited by 183 publications

(83 citation statements)

References 17 publications

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“…Rigaud 67 showed similar results with elemental and polymeric diets used as primary therapy for steroid-unresponsive CD. This fact suggests that some patients may benefit from NT after drug treatment failure 15 In a prospective study comparing TPN, oral diets plus TPN and elemental diets, Greenberg et al 31 observed no significant differences on remission, concluding that the benefits of these regimens were due to nutritional improvement.…”

Section: Enteral Nutrition (En)supporting

confidence: 57%

“…EN efficacy is also limited by disease location, once ileal disease has a faster and more complete response to treatment when compared to more diffuse disease or colonic or perianal disease 15,33 . Another limitation is the early relapse that occurs in 60 to 70% of patients in one year 67 . Despite the benefit of early remission induction on active CD, further data are necessary for better evaluation of enteral diet therapy on CD complicated by fistula and stenosis.…”

Section: Enteral Nutrition (En)mentioning

confidence: 99%

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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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Section: Enteral Nutrition (En)supporting

confidence: 57%

Section: Enteral Nutrition (En)mentioning

confidence: 99%

Inflammatory bowel diseases: principles of nutritional therapy

et al. 2002

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“…Both were already shown to be equally efficient as primary therapies for active CD. 21 Differences in nitrogen sources of enteral feeds are not relevant to their therapeutic efficacy, as elemental diets and polymeric diets are equally effective. 22 The results of this study were consistent with previous reports indicating that EN is efficacious for maintaining clinical remission of patients with CD and elemental diets and polymeric diets were equally effective.…”

Section: Discussionmentioning

confidence: 99%

Concomitant use of enteral nutrition therapy is associated with sustained response to infliximab in patients with Crohn’s disease

Sazuka¹,

Katsuno²,

Nakagawa³

et al. 2012

Eur J Clin Nutr

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BACKGROUND/OBJECTIVES: A significant proportion of Crohn's disease (CD) patients receiving infliximab (IFX) maintenance therapy show loss of responsiveness despite a good initial response. The factors other than immunomodulators that prevent IFX dose escalation have yet to be fully elucidated. This study was performed to identify clinical factors or concomitant therapies associated with sustained response to IFX. SUBJECTS/METHODS: Seventy-four consecutive CD patients who had successful IFX induction therapy between 2002 and 2010 underwent IFX maintenance therapy. Patients showing loss of response to IFX were treated with IFX intensification therapy. Factors involved in the sustained response to IFX were investigated retrospectively. RESULTS: After a median follow-up of 85 weeks, loss of response to IFX was observed in 30 (40.5%) cases. On logistic regression analysis, concomitant use of enteral nutrition (EN) therapy (elemental and/or polymeric formulas) was identified as an independent factor associated with sustained response to IFX. Receiver operating characteristic curve analysis indicated a cutoff value of 600 kcal/day. We divided the patients into the 'EN group' (X600 kcal/day) and 'control group' (o600 kcal/day). The cumulative number of loss of response was significantly lower in the EN group (odds ratio: 0.23, P ¼ 0.0043). Kaplan-Meier analysis confirmed the significantly lower rate of loss of response in the EN group (P ¼ 0.013). Multivariate hazard ratio was 0.37 (P ¼ 0.025). Type of EN formula did not affect the results. CONCLUSIONS: Concomitant use of EN X600 kcal/day is likely to yield a sustained response to IFX in CD patients.

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“…Defined formula diets are usually more palatable and less expensive than are the elemental diets. While some investigators report no differences between elemental and defined formula diets in patients with acute CD [49,59,60] , Giaffer et al [61] found elemental diets to be more effective in active CD. A randomized double-blind trial in Crohn's patients demonstrated that elemental and polymeric (defined) diets, differing only in their source of nitrogen, were equally effective in reducing the Crohn's disease activity index (CDAI), and in inducing clinical remission [62] .…”

Section: Total Parenteral Nutrition (Tpn)mentioning

confidence: 99%

Nutritional modulation of the inflammatory response in inflammatory bowel disease- From the molecular to the integrative to the clinical

Wild¹,

Drozdowski²,

Tartaglia³

et al. 2007

WJG

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Nutrient deficiencies are common in patients with inflammatory bowel disease (IBD). Both total parenteral and enteral nutrition provide important supportive therapy for IBD patients, but in adults these are not useful for primary therapy. Dietary intervention with omega-3 polyunsaturated fatty acids contained in fish oil may be useful for the care of IBD patients, and recent studies have stressed the role of PPAR on NFκB activity on the potential beneficial effect of dietary lipids on intestinal function.

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Controlled trial comparing two types of enteral nutrition in treatment of active Crohn's disease: elemental versus polymeric diet.

Abstract: To determine whether an

Cited by 183 publications

References 17 publications

Inflammatory bowel diseases: principles of nutritional therapy

Inflammatory bowel diseases: principles of nutritional therapy

Concomitant use of enteral nutrition therapy is associated with sustained response to infliximab in patients with Crohn’s disease

Nutritional modulation of the inflammatory response in inflammatory bowel disease- From the molecular to the integrative to the clinical

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