Microbiome Associations of Therapeutic Enteral Nutrition

Abstract

One of the most effective forms of therapeutic enteral nutrition is designated as “exclusive enteral nutrition” (EEN). EEN constitutes the monotonous enteral delivery of complete liquid nutrition and has been most explored in the treatment Crohn’s disease (CD), a form of inflammatory bowel disease. While EEN’s mechanisms of action are not clearly understood, it has been shown to modify the composition of the intestinal microbiome, an important component of CD pathogenesis. The current literature on the intestinal microbiome in healthy individuals and CD patients is reviewed with respect to EEN therapy. Further investigations in this field are needed to better understand the role and potential for EEN in chronic human disorders.

Recent Advances in Enteral Nutrition

“…There is evidence that malnutrition is a common effect of inflammatory bowel disease and diet has been implicated in its pathogenesis and clinical manifestation [18]. In addition, diet also has a role in the management of inflammatory bowel disease and the need for enteral nutrition support becomes critical when oral dietary intake is not sufficient to offer all the nutritional requirements [19]. Enteral nutrition has shown promising results in the management of Crohn’s disease as it provides equal or higher remission rates than current medications in use [18].…”

“…In a related study, exclusive enteral nutrition—the monotonous enteral delivery of complete liquid nutrition—has been explored in the management of Crohn’s disease [19]. Exclusive enteral nutrition is usually in the form of liquid enteral formulas which may be elemental (e.g., in the form of amino acids) or polymeric (e.g., in the form of intact protein) [19].…”

“…Exclusive enteral nutrition is usually in the form of liquid enteral formulas which may be elemental (e.g., in the form of amino acids) or polymeric (e.g., in the form of intact protein) [19]. Although the mechanism of action of exclusive enteral nutrition is still evolving, there is evidence that it could modify the composition of intestinal microbiome which are essential in the pathogenesis of Crohn’s disease [19]. It would appear that exclusive enteral nutrition is better than steroids in the induction of mucosal healing and may provide long-term remission in some cases of Crohn’s disease [19].…”

Enteral nutrition is associated with a decreased risk of surgical intervention in Crohn’s disease patients with spontaneous intra-abdominal abscess

“…This restoration of gut barrier morphology and function is closely related with a mechanism involving the inhibition of long myosin light chain kinase (MLCK) (39). Moreover, previous studies (23,25,29,40,41) have indicated that EN modulates the gut microbiota which is linked with CD disease activity and thus exerts a beneficial effect on the recovery of bowel function. Interestingly, it was suggested that ileal enterocytes might experience nutrient stress during EN treatment as the amino acid requirements of enterocytes were primarily provided by first pass catabolism of a lumen-supplied dietary amino acids and enterocytes were limited in their ability to utilize arterial supplied amino acids (42).…”

Oral Diets and Nutrition Support for Inflammatory Bowel Disease

“…EN, as an exclusive or supplemental form of nutrition, has generated interest as a treatment modality for IBD, while possibly reducing reliance on pharmacologic immunosuppressants. Although the exact mechanisms are unclear, the use of EN in IBD is hypothesized to promote mucosal healing in the gastrointestinal tract by favorably altering the intestinal microbiota, reducing intestinal permeability, enhancing barrier defense and adaptation, and promoting a reduction of proinflammatory cytokines 66 . Several prospective studies have shown that both pediatric and adult patients with active CD achieved remission, had endoscopic and histologic healing, and exhibited lower proinflammatory cytokine levels in mucosal biopsies after receiving short‐term EN 67 , 68 .…”