Steroids and Bowel Rest Versus Elemental Diet in the Treatment of Patients with Crohn's Disease: The Effects on Protein Metabolism and Immune Function

Abstract

Recent studies have shown an elemental diet to be as effective as bowel rest plus steroids in the management of acute Crohn's disease. In order to investigate the metabolic and immunological effects of these two therapies, six patients with an acute inflammatory attack of ileal Crohn's disease were randomly assigned to receive steroids or elemental diet for 7 days. Immunological and protein metabolic studies were performed before and after therapy, protein kinetic rates being measured by the method of constant intravenous infusion of 14C-labeled leucine tracer. Clinical and symptomatic improvement was noted in all six patients with significant falls in sedimentation rate and platelet counts and increases in albumin concentrations. Both forms of treatment increased plasma amino acid flux and oxidation rates, whole body protein turnover and rates of incorporation of amino acid into albumin. However, the increased rates of protein metabolism in the patients given steroids were at the expense of body protein stores with a net (average) loss of 58 g of nitrogen over 7 days. While both forms of therapy were associated with suppression of lymphocyte subsets, complement and circulating immune complexes only the steroid regimen was associated with suppression of in vivo IgG synthesis rates. The results indicated that both forms of therapy were associated with clinical improvement, increases in protein turnover and evidence of reduced inflammatory activity. However, the beneficial effects of steroid regimen must be balanced against the deleterious effects on body protein stores; steroids and bowel rest without nutritional support should be avoided in malnourished patients.

Growth in Paediatric Crohn’s Disease

“…It has shown spectacular results on growth and also controls disease activity and prevents relapses [24, 25, 26, 27, 28, 29, 30, 31, 32, 33]. The results were obtained using oral supplements or home cyclic nocturnal enteral nutrition used daily for months [24, 26, 27, 30, 31, 32]or intermittently [29]. Growth was stimulated with various type of feeds: elemental, semi-elemental or polymeric [26, 29, 30, 31].…”

“…This report reviews the data concerning growth failure in paediatric CD [1, 2, 3, 4, 5, 6], how it comes about [3, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21]and the effect of new therapeutic strategies [22, 23, 24, 25, 26, 27, 28, 29, 30, 31]. …”

Defined-Formula Diets versus Steroids in the Treatment of Active Crohn's Disease A Meta-Analysis

“…In the treatment of active Crohn's disease, defined-formula diets (DFDs) have been proposed as an alternative to standard treatment with steroids (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). Whereas the effectiveness of steroids is well established (l), the role of DFDs remains controversial because the controlled clinical trials comparing DFDs with steroids have given conflicting results (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14).…”

Severe and Steroid-Resistant Crohn’s Disease

“…Several controlled and uncontrolled studies evaluated the benefit of elemental or nonelemental diets for the induction of remission in CD [53,54,55,56,57,58,59]. Their results, somewhat conflicting, prompted 3 meta-analyses that concurred in concluding that dietary approaches were less effective than steroids in inducing remission of CD in adults [60,61,62].…”