Predictors of response to enteral nutrition in abdominal enterocutaneous fistula patients with Crohn's disease

Yan, Dongsheng; Ren, Jianan; Wang, G; Liu, S; Li, J

doi:10.1038/ejcn.2014.31

Cited by 43 publications

(43 citation statements)

References 33 publications

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“…In a group of adult patients with inflammatory stricturing CD ( n = 59), EEN administered for 12 weeks achieved radiological remission of stricturing disease in 54% and resolution of clinical symptoms in 65% of patients . Similarly, in patients with enterocutaneous fistulae, two small studies have shown that 12 weeks of EEN led to fistula closure in 62.5–75% of patients . In those with intra‐abdominal collections, use of EEN for over 12 weeks was associated with resolution of collection in 76% of patients .…”

Section: Resultsmentioning

confidence: 99%

“…26 Similarly, in patients with enterocutaneous fistulae, two small studies have shown that 12 weeks of EEN led to fistula closure in 62.5-75% of patients. 27,28 In those with intraabdominal collections, use of EEN for over 12 weeks was associated with resolution of collection in 76% of patients. 28 There are no data on EEN for perianal CD in adults, although there are several case reports describing efficacy in pediatric patients.…”

Section: Statement 1: Clinical Indications For Een Therapy In Adults mentioning

confidence: 99%

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Exclusive enteral nutrition: An optimal care pathway for use in adult patients with active Crohn's disease

et al. 2019

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Background and Aim Exclusive enteral nutrition (EEN) is progressively being used as a therapeutic option for adults with Crohn's Disease (CD); however, there is no standardized approach to delivering this therapy. The aim of this study is to develop an optimal care pathway for using EEN in adults with CD. This will create a standard of care that can be used as a benchmark practice and will provide direction for future research. Methods A working group of 12 multidisciplinary inflammatory bowel disease specialists across Australia and New Zealand was convened to develop a practical, clinically focused care pathway for using EEN in adults with active CD. Six key areas were identified as part of the care pathway: clinical indications, nutrition assessment, EEN protocol, monitoring, accessing formula, and food reintroduction. Current literature was identified via systematic review, and quality of evidence was graded. Consensus expert opinion was used where literature gaps were identified. Results An optimal care pathway for using EEN in adults with CD was developed with six key consensus statements on how to use EEN in adults with active CD. These key statements identify clinical indications for use, nutrition assessment, enteral prescription and duration of therapy, monitoring criteria, food reintroduction, and the role of partial EEN. An accompanying patient resource was also developed. Conclusion EEN is recommended as a treatment option to induce remission in adults with active CD. The consensus statements developed are practical and are based on best available evidence and expert opinion to assist in developing a standardized approach to delivering EEN therapy.

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Section: Resultsmentioning

confidence: 99%

Section: Statement 1: Clinical Indications For Een Therapy In Adults mentioning

confidence: 99%

Exclusive enteral nutrition: An optimal care pathway for use in adult patients with active Crohn's disease

et al. 2019

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“…A preoperative lag allowed for amelioration of patient conditions – reducing the inflammatory environment [58-60], increasing serum albumin [59, 60], weaning or suspending CST therapy [57, 59], and treating abscesses [59, 60] – as opposed to patients operated on immediately [58, 59]. These properties have also been attributed to nutritional support, both enteral and parenteral, by other authors [44, 47, 48, 50, 52-54, 69-72]. Also, in one of the reviewed studies [59], going straight to surgery (non-EEN patients) was an independent risk factor for anastomotic leaks and/or intra-abdominal abscesses.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Enteral Nutrition and Surgical Outcomes in Adults with Crohn’s Disease: A Systematic Review

Rocha

Bessa

Lago

et al. 2018

GE Port J Gastroenterol

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Background and Aim: Enteral nutrition (EN) is applicable to adult Crohn’s disease (CD) in treating malnutrition and in inducing remission – here as a less effective alternative than corticosteroids. The purpose of this review is to determine whether preoperative EN impacts postoperative complications of adult CD, either by means of nutritional or therapeutic effects. Summary: A systematic review of English written full-text research articles published between January 1990 and November 2017, including adult patients undergoing abdominal surgery for complicated CD after EN, was performed. Four studies out of 22 were selected, all of which institutional, retrospective, case-control cohorts, one classified as “good quality” and three as “poor quality,” as rated by the Newcastle-Ottawa Scale. The application of inclusion and exclusion criteria resulted in a non-intentional absence of studies referring to supplemental EN among those reviewed. The reduced number of heterogeneous eligible studies impeded meta-analysis. In all studies, exclusive EN (EEN) was used and well tolerated, allowing to defer or even avoid surgery altogether, improving patients’ global state. The two studies with the greatest number of patients found preoperative EEN to be an independent factor against infectious and non-infectious complications in 219 patients and against anastomotic leaks or abscesses in 38 patients. Also, in univariate analysis, EEN was found to increase preoperative immunosuppressant-free intervals and to protect against anastomotic dehiscences, intra-abdominal abscesses, surgical wound infections, ileus, stomas, and reoperations in the largest study; in another study it was related to fewer intra-abdominal septic complications. Key Messages: All reviewed studies are retrospective and, consequently, of limited relevance. Nonetheless, all of them call the attention of the scientific community to the potential benefits of preoperative EEN on postoperative outcomes in adult CD, calling for prospective multi-institutional studies and randomized controlled trials.

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“…Most occur post-operatively. It is demonstrated that in surgical patients, early nutritional support, independently of the route of administration, decreases the occurrence and severity of fistulae [84,98,99]. Malnutrition with BMI <20 appears as an independent risk factor [100].…”

Section: Grade Of Recommendation B E Strong Consensus (96% Agreement)mentioning

confidence: 99%

ESPEN practical guideline: Clinical Nutrition in inflammatory bowel disease

et al. 2020

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Predictors of response to enteral nutrition in abdominal enterocutaneous fistula patients with Crohn's disease

Abstract: In CD patients with ECF, lower CRP and higher BMI are associated with higher possibility of closure after EN treatment. EN therapy can lead to a closure of ECF in a certain proportion of patients. EN therapy could also ameliorate inflammatory condition and improve nutrition status.

Cited by 43 publications

References 33 publications

Exclusive enteral nutrition: An optimal care pathway for use in adult patients with active Crohn's disease

Exclusive enteral nutrition: An optimal care pathway for use in adult patients with active Crohn's disease

Preoperative Enteral Nutrition and Surgical Outcomes in Adults with Crohn’s Disease: A Systematic Review

ESPEN practical guideline: Clinical Nutrition in inflammatory bowel disease

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