Initial response and subsequent course of Crohn's disease treated with elemental diet or prednisolone.

Gorard, Stephen; Hunt, John B.; Payne-James, Jason; Palmer, K R; Rees, R. G. P.; Clark, M. L.; Farthing, M. J. G.; Misiewicz, J. J.; Silk, D. B. A.

doi:10.1136/gut.34.9.1198

Cited by 162 publications

(87 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The use of elemental diets to induce remission in Crohn's disease is well established (O'Morain et al, 1984;Saverymuttu et al, 1985;Gorard et al, 1993). Acute radiation bowel damage is also characterised by an inflammatory response.…”

Section: Discussionmentioning

confidence: 99%

Role of nutritional intervention in patients treated with radiotherapy for pelvic malignancy

et al. 2004

View full text Add to dashboard Cite

Up to 12 000 patients with gynaecological, urological and rectal cancer undergo radical pelvic radiotherapy annually in the UK. More than 70% develop acute inflammatory changes causing gastrointestinal symptoms during treatment because healthy bowel tissue is encompassed in the radiation field. In total, 50% go on to develop chronic bowel symptoms, which affect quality of life due to permanent changes in the small and large intestine. Nutritional intervention may influence acute and chronic bowel symptoms but the validity of the advice given to patients is not clear. To assess the incidence and significance of malnutrition and to examine the efficacy of therapeutic nutritional interventions used to manage gastrointestinal side effects in patients undergoing pelvic radiotherapy and those with chronic bowel side effects after treatment, a critical review of relevant original studies on human subjects was carried out using a specific set of mesh terms in MEDLINE and EMBASE databases and the Cochrane Library in September 2003. Full texts of all relevant articles were collected and reference lists were checked. Sources of grey literature including conference abstracts and webbased information were also reviewed. A total of 36 papers published in peer-reviewed journals between 1966 and 2003 were identified. In all, 14 randomised controlled trials, 12 prospective cohorts, four retrospective, two qualitative, one validation, one pilot study and two case reports were obtained. These included 2646 patients. Eight articles including three conference abstracts and webbased information were found. None of the studies was definitive because of weakness in methodology. No studies could be combined because the interventions and the end points were different. There is no evidence base for the use of nutritional interventions to prevent or manage bowel symptoms attributable to radiotherapy. Low-fat diets, probiotic supplementation and elemental diet merit further investigation.

show abstract

Section: Discussionmentioning

confidence: 99%

Role of nutritional intervention in patients treated with radiotherapy for pelvic malignancy

et al. 2004

View full text Add to dashboard Cite

show abstract

“…Meta-analyses of randomized controlled trials also favor drug therapy over EN regarding remission of active CD in adults 22,34 . Moreover, results about late remission rates reached the same conclusion 29 , although the use of exclusion diets may improve late remission rates 68 .…”

Section: Enteral Nutrition (En)mentioning

confidence: 59%

Inflammatory bowel diseases: principles of nutritional therapy

et al. 2002

View full text Add to dashboard Cite

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.

show abstract

“…There is still some discussion as to whether ED has a direct effect on the gut, or whether the efficacy of ED is due to indirect effects such as improvement in nutritional status. In one study of ED in CD, both nourished and malnourished patients responded equally (Gorard et al 1993). Other researchers have found that clinical improvement in disease activity occurred before changes in nutritional status were detected (Teahon et al 1995;Croft et al 2001), suggesting that ED has a direct effect on the gut.…”

Section: Mechanism Of Actionmentioning

confidence: 96%

Modification of enteral diets in inflammatory bowel disease

Aldhous

Meister

2001

Proc. Nutr. Soc.

View full text Add to dashboard Cite

The provision of food is thought to promote the maintenance of gut integrity. Nutrients are able to elicit and affect both systemic and mucosal immune responses. Enteral diet therapy has long been known to be efficacious in inflammatory bowel disease (IBD), particularly in childhood Crohn's disease. However, the mechanisms of action of these diets are not clear. Nutritional repletion, direct effects on the gut mucosa or decreased intestinal permeability have all been postulated as being important in nutritional therapy. There is some evidence that the enteral diet has a direct effect on the gut mucosa by reducing cytokine production and the accompanying inflammation, thus leading to decreased intestinal permeability. Modifications of enteral diet composition have been evaluated in many studies. Such modifications include fat and/or protein content and the addition of bioactive peptides. The fatty acid composition of the enteral diet seems to have a much greater impact on its efficacy than modification of the N source. As specific fatty acids are precursors of inflammatory mediators derived from arachidonic acid, the reduction in these components may be beneficial in nutritional therapy for IBD. Addition of bioactive peptides to enteral diet formulas may also have a role; such peptides may have specific growth factor or anti-inflammatory actions. There is still much work to be done to define disease-specific enteral diet formulas that are effective as therapies for both Crohn's disease and ulcerative colitis.

show abstract

Initial response and subsequent course of Crohn's disease treated with elemental diet or prednisolone.

Cited by 162 publications

References 29 publications

Role of nutritional intervention in patients treated with radiotherapy for pelvic malignancy

Role of nutritional intervention in patients treated with radiotherapy for pelvic malignancy

Inflammatory bowel diseases: principles of nutritional therapy

Modification of enteral diets in inflammatory bowel disease

Contact Info

Product

Resources

About