Enteral Nutrition in the Management of Pediatric and Adult Crohn’s Disease
Abstract
:1. Introduction
2. Enteral Nutrition Formulas
3. Mechanism of Action
4. Exclusive Enteral Nutrition in the Induction of Remission in Pediatric Crohn’s Disease
5. Supplemental Enteral Nutrition and the Maintenance of Remission in Pediatric Crohn’s Disease
6. Exclusive Enteral Nutrition in the Induction of Remission of Adult Crohn’s Disease
7. Supplemental Enteral Nutrition and Maintenance of Remission in Adult Crohn’s Disease
8. Implementation of Exclusive Enteral Nutrition
9. Conclusions
Author Contributions
Conflicts of Interest
References
- Lichtenstein, G.R.; Hanauer, S.B.; Sandborn, W.J. Practice Parameters Committee of American College of, G. Management of crohn’s disease in adults. Am. J. Gastroenterol. 2009, 104, 465–483. [Google Scholar] [CrossRef] [PubMed]
- Voitk, A.J.; Echave, V.; Feller, J.H.; Brown, R.A.; Gurd, F.N. Experience with elemental diet in the treatment of inflammatory bowel disease. Is this primary therapy? Arch. Surg. 1973, 107, 329–333. [Google Scholar] [CrossRef] [PubMed]
- Wall, C.L.; Day, A.S.; Gearry, R.B. Use of exclusive enteral nutrition in adults with crohn’s disease: A review. World J. Gastroenterol. 2013, 19, 7652–7660. [Google Scholar] [CrossRef] [PubMed]
- Ruemmele, F.M.; Veres, G.; Kolho, K.L.; Griffiths, A.; Levine, A.; Escher, J.C.; Amil Dias, J.; Barabino, A.; Braegger, C.P.; Bronsky, J.; et al. Consensus guidelines of ecco/espghan on the medical management of pediatric crohn’s disease. J. Crohns Colitis 2014, 8, 1179–1207. [Google Scholar] [CrossRef] [PubMed]
- Akobeng, A.K.; Thomas, A.G. Enteral nutrition for maintenance of remission in crohn’s disease. Cochrane Database Syst. Rev. 2007, CD005984. [Google Scholar] [CrossRef] [PubMed]
- Escuro, A.A.; Hummell, A.C. Enteral formulas in nutrition support practice: Is there a better choice for your patient? Nutr. Clin. Pract. 2016, 31, 709–722. [Google Scholar] [CrossRef] [PubMed]
- Gong, D.; Yu, X.; Wang, L.; Kong, L.; Gong, X.; Dong, Q. Exclusive enteral nutrition induces remission in pediatric crohn’s disease via modulation of the gut microbiota. Biomed. Res. Int. 2017, 2017, 8102589. [Google Scholar] [CrossRef] [PubMed]
- Butler, M.; Boyle, J.J.; Powell, J.J.; Playford, R.J.; Ghosh, S. Dietary microparticles implicated in crohn’s disease can impair macrophage phagocytic activity and act as adjuvants in the presence of bacterial stimuli. Inflamm. Res. 2007, 56, 353–361. [Google Scholar] [CrossRef] [PubMed]
- Lee, J.; Allen, R.; Ashley, S.; Becker, S.; Cummins, P.; Gbadamosi, A.; Gooding, O.; Huston, J.; Le Couteur, J.; O’Sullivan, D.; et al. British dietetic association evidence-based guidelines for the dietary management of crohn’s disease in adults. J. Hum. Nutr. Diet. 2014, 27, 207–218. [Google Scholar] [CrossRef] [PubMed]
- Forbes, A.; Escher, J.; Hebuterne, X.; Klek, S.; Krznaric, Z.; Schneider, S.; Shamir, R.; Stardelova, K.; Wierdsma, N.; Wiskin, A.E.; et al. Espen guideline: Clinical nutrition in inflammatory bowel disease. Clin. Nutr. 2017, 36, 321–347. [Google Scholar] [CrossRef] [PubMed]
- Makola, D. Elemental and semi-elemental formulas: Are they superior to polymeric formulas? Pract. Gastroenterol. 2005, 14, 59–64. [Google Scholar]
- Zachos, M.; Tondeur, M.; Griffiths, A.M. Enteral nutritional therapy for induction of remission in crohn’s disease. Cochrane Database Syst. Rev. 2007, CD000542. [Google Scholar] [CrossRef] [PubMed]
- Bernstein, C.N. Review article: Changes in the epidemiology of inflammatory bowel disease-clues for aetiology. Aliment. Pharmacol. Ther. 2017, 46, 911–919. [Google Scholar] [CrossRef] [PubMed]
- Alhagamhmad, M.H.; Day, A.S.; Lemberg, D.A.; Leach, S.T. Exploring and enhancing the anti-inflammatory properties of polymeric formula. J. Parenter. Enter. Nutr. 2017, 41, 436–445. [Google Scholar] [CrossRef] [PubMed]
- Darfeuille-Michaud, A.; Boudeau, J.; Bulois, P.; Neut, C.; Glasser, A.L.; Barnich, N.; Bringer, M.A.; Swidsinski, A.; Beaugerie, L.; Colombel, J.F. High prevalence of adherent-invasive escherichia coli associated with ileal mucosa in crohn’s disease. Gastroenterology 2004, 127, 412–421. [Google Scholar] [CrossRef] [PubMed]
- Hegazy, A.N.; West, N.R.; Stubbington, M.J.T.; Wendt, E.; Suijker, K.I.M.; Datsi, A.; This, S.; Danne, C.; Campion, S.; Duncan, S.H.; et al. Circulating and tissue-resident cd4(+) t cells with reactivity to intestinal microbiota are abundant in healthy individuals and function is altered during inflammation. Gastroenterology 2017, 153, 1320–1337. [Google Scholar] [CrossRef] [PubMed]
- Wu, G.D.; Chen, J.; Hoffmann, C.; Bittinger, K.; Chen, Y.Y.; Keilbaugh, S.A.; Bewtra, M.; Knights, D.; Walters, W.A.; Knight, R.; et al. Linking long-term dietary patterns with gut microbial enterotypes. Science 2011, 334, 105–108. [Google Scholar] [CrossRef] [PubMed]
- Zimmer, J.; Lange, B.; Frick, J.S.; Sauer, H.; Zimmermann, K.; Schwiertz, A.; Rusch, K.; Klosterhalfen, S.; Enck, P. A vegan or vegetarian diet substantially alters the human colonic faecal microbiota. Eur. J. Clin. Nutr. 2012, 66, 53–60. [Google Scholar] [CrossRef] [PubMed]
- Pavlidis, P.; Powell, N.; Vincent, R.P.; Ehrlich, D.; Bjarnason, I.; Hayee, B. Systematic review: Bile acids and intestinal inflammation-luminal aggressors or regulators of mucosal defence? Aliment. Pharmacol. Ther. 2015, 42, 802–817. [Google Scholar] [CrossRef] [PubMed]
- David, L.A.; Maurice, C.F.; Carmody, R.N.; Gootenberg, D.B.; Button, J.E.; Wolfe, B.E.; Ling, A.V.; Devlin, A.S.; Varma, Y.; Fischbach, M.A.; et al. Diet rapidly and reproducibly alters the human gut microbiome. Nature 2014, 505, 559–563. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Yoshimoto, S.; Loo, T.M.; Atarashi, K.; Kanda, H.; Sato, S.; Oyadomari, S.; Iwakura, Y.; Oshima, K.; Morita, H.; Hattori, M.; et al. Obesity-induced gut microbial metabolite promotes liver cancer through senescence secretome. Nature 2013, 499, 97–101. [Google Scholar] [CrossRef] [PubMed]
- Quince, C.; Ijaz, U.Z.; Loman, N.; Eren, A.M.; Saulnier, D.; Russell, J.; Haig, S.J.; Calus, S.T.; Quick, J.; Barclay, A.; et al. Extensive modulation of the fecal metagenome in children with crohn’s disease during exclusive enteral nutrition. Am. J. Gastroenterol. 2015, 110, 1718–1729; quiz 1730. [Google Scholar] [CrossRef] [PubMed]
- Gerasimidis, K.; Bertz, M.; Hanske, L.; Junick, J.; Biskou, O.; Aguilera, M.; Garrick, V.; Russell, R.K.; Blaut, M.; McGrogan, P.; et al. Decline in presumptively protective gut bacterial species and metabolites are paradoxically associated with disease improvement in pediatric crohn’s disease during enteral nutrition. Inflamm. Bowel Dis. 2014, 20, 861–871. [Google Scholar] [CrossRef] [PubMed]
- De Jong, N.S.; Leach, S.T.; Day, A.S. Polymeric formula has direct anti-inflammatory effects on enterocytes in an in vitro model of intestinal inflammation. Dig. Dis. Sci. 2007, 52, 2029–2036. [Google Scholar] [CrossRef] [PubMed]
- Meister, D.; Bode, J.; Shand, A.; Ghosh, S. Anti-inflammatory effects of enteral diet components on crohn’s disease-affected tissues in vitro. Dig. Liver Dis. 2002, 34, 430–438. [Google Scholar] [CrossRef]
- Yamamoto, T.; Nakahigashi, M.; Umegae, S.; Kitagawa, T.; Matsumoto, K. Impact of elemental diet on mucosal inflammation in patients with active crohn’s disease: Cytokine production and endoscopic and histological findings. Inflamm. Bowel Dis. 2005, 11, 580–588. [Google Scholar] [CrossRef] [PubMed]
- Fell, J.M.; Paintin, M.; Arnaud-Battandier, F.; Beattie, R.M.; Hollis, A.; Kitching, P.; Donnet-Hughes, A.; MacDonald, T.T.; Walker-Smith, J.A. Mucosal healing and a fall in mucosal pro-inflammatory cytokine mrna induced by a specific oral polymeric diet in paediatric crohn’s disease. Aliment. Pharmacol. Ther. 2000, 14, 281–289. [Google Scholar] [CrossRef] [PubMed]
- Lomer, M.C.; Thompson, R.P.; Powell, J.J. Fine and ultrafine particles of the diet: Influence on the mucosal immune response and association with crohn’s disease. Proc. Nutr. Soc. 2002, 61, 123–130. [Google Scholar] [CrossRef] [PubMed]
- Lomer, M.C.; Grainger, S.L.; Ede, R.; Catterall, A.P.; Greenfield, S.M.; Cowan, R.E.; Vicary, F.R.; Jenkins, A.P.; Fidler, H.; Harvey, R.S.; et al. Lack of efficacy of a reduced microparticle diet in a multi-centred trial of patients with active crohn’s disease. Eur. J. Gastroenterol. Hepatol. 2005, 17, 377–384. [Google Scholar] [CrossRef] [PubMed]
- Kugathasan, S.; Judd, R.H.; Hoffmann, R.G.; Heikenen, J.; Telega, G.; Khan, F.; Weisdorf-Schindele, S.; San Pablo, W., Jr.; Perrault, J.; Park, R.; et al. Epidemiologic and clinical characteristics of children with newly diagnosed inflammatory bowel disease in wisconsin: A statewide population-based study. J. Pediatr. 2003, 143, 525–531. [Google Scholar] [CrossRef]
- Benchimol, E.I.; Fortinsky, K.J.; Gozdyra, P.; Van den Heuvel, M.; Van Limbergen, J.; Griffiths, A.M. Epidemiology of pediatric inflammatory bowel disease: A systematic review of international trends. Inflamm. Bowel Dis. 2011, 17, 423–439. [Google Scholar] [CrossRef] [PubMed]
- Dziechciarz, P.; Horvath, A.; Shamir, R.; Szajewska, H. Meta-analysis: Enteral nutrition in active crohn’s disease in children. Aliment. Pharmacol. Ther. 2007, 26, 795–806. [Google Scholar] [CrossRef] [PubMed]
- Heuschkel, R.B.; Menache, C.C.; Megerian, J.T.; Baird, A.E. Enteral nutrition and corticosteroids in the treatment of acute crohn’s disease in children. J. Pediatr. Gastroenterol. Nutr. 2000, 31, 8–15. [Google Scholar] [CrossRef] [PubMed]
- Swaminath, A.; Feathers, A.; Ananthakrishnan, A.N.; Falzon, L.; Li Ferry, S. Systematic review with meta-analysis: Enteral nutrition therapy for the induction of remission in paediatric crohn’s disease. Aliment. Pharmacol. Ther. 2017, 46, 645–656. [Google Scholar] [CrossRef] [PubMed]
- Frivolt, K.; Schwerd, T.; Werkstetter, K.J.; Schwarzer, A.; Schatz, S.B.; Bufler, P.; Koletzko, S. Repeated exclusive enteral nutrition in the treatment of paediatric crohn’s disease: Predictors of efficacy and outcome. Aliment. Pharmacol. Ther. 2014, 39, 1398–1407. [Google Scholar] [CrossRef] [PubMed]
- Wilschanski, M.; Sherman, P.; Pencharz, P.; Davis, L.; Corey, M.; Griffiths, A. Supplementary enteral nutrition maintains remission in paediatric crohn’s disease. Gut 1996, 38, 543–548. [Google Scholar] [CrossRef] [PubMed]
- Buchanan, E.; Gaunt, W.W.; Cardigan, T.; Garrick, V.; McGrogan, P.; Russell, R.K. The use of exclusive enteral nutrition for induction of remission in children with crohn’s disease demonstrates that disease phenotype does not influence clinical remission. Aliment. Pharmacol. Ther. 2009, 30, 501–507. [Google Scholar] [CrossRef] [PubMed]
- Afzal, N.A.; Davies, S.; Paintin, M.; Arnaud-Battandier, F.; Walker-Smith, J.A.; Murch, S.; Heuschkel, R.; Fell, J. Colonic crohn’s disease in children does not respond well to treatment with enteral nutrition if the ileum is not involved. Dig. Dis. Sci. 2005, 50, 1471–1475. [Google Scholar] [CrossRef] [PubMed]
- Luo, Y.; Yu, J.; Lou, J.; Fang, Y.; Chen, J. Exclusive enteral nutrition versus infliximab in inducing therapy of pediatric crohn’s disease. Gastroenterol. Res. Pract. 2017, 2017, 6595048. [Google Scholar] [CrossRef] [PubMed]
- Cuiv, P.O.; Begun, J.; Keely, S.; Lewindon, P.J.; Morrison, M. Towards an integrated understanding of the therapeutic utility of exclusive enteral nutrition in the treatment of crohn’s disease. Food Funct. 2016, 7, 1741–1751. [Google Scholar] [CrossRef] [PubMed]
- Duncan, H.; Buchanan, E.; Cardigan, T.; Garrick, V.; Curtis, L.; McGrogan, P.; Barclay, A.; Russell, R.K. A retrospective study showing maintenance treatment options for paediatric cd in the first year following diagnosis after induction of remission with een: Supplemental enteral nutrition is better than nothing! BMC Gastroenterol. 2014, 14, 50. [Google Scholar] [CrossRef] [PubMed]
- Cohen-Dolev, N.; Sladek, M.; Hussey, S.; Turner, D.; Veres, G.; Koletzko, S.; Martin de Carpi, J.; Staiano, A.; Shaoul, R.; Lionetti, P.; et al. Differences in outcomes over time with exclusive enteral nutrition compared with steroids in children with mild to moderate crohn’s disease: Results from the growth cd study. J. Crohns Colitis 2018, 12, 306–312. [Google Scholar] [CrossRef] [PubMed]
- Lafferty, L.; Tuohy, M.; Carey, A.; Sugrue, S.; Hurley, M.; Hussey, S. Outcomes of exclusive enteral nutrition in paediatric crohn’s disease. Eur. J. Clin. Nutr. 2017, 71, 185–191. [Google Scholar] [CrossRef] [PubMed]
- Knight, C.; El-Matary, W.; Spray, C.; Sandhu, B.K. Long-term outcome of nutritional therapy in paediatric crohn’s disease. Clin. Nutr. 2005, 24, 775–779. [Google Scholar] [CrossRef] [PubMed]
- Werkstetter, K.J.; Schatz, S.B.; Alberer, M.; Filipiak-Pittroff, B.; Koletzko, S. Influence of exclusive enteral nutrition therapy on bone density and geometry in newly diagnosed pediatric crohn’s disease patients. Ann. Nutr. Metab. 2013, 63, 10–16. [Google Scholar] [CrossRef] [PubMed]
- Berni Canani, R.; Terrin, G.; Borrelli, O.; Romano, M.T.; Manguso, F.; Coruzzo, A.; D’Armiento, F.; Romeo, E.F.; Cucchiara, S. Short- and long-term therapeutic efficacy of nutritional therapy and corticosteroids in paediatric crohn’s disease. Dig. Liver Dis. 2006, 38, 381–387. [Google Scholar] [CrossRef] [PubMed]
- Lambert, B.; Lemberg, D.A.; Leach, S.T.; Day, A.S. Longer-term outcomes of nutritional management of crohn’s disease in children. Dig. Dis. Sci. 2012, 57, 2171–2177. [Google Scholar] [CrossRef] [PubMed]
- Beattie, R.M.; Schiffrin, E.J.; Donnet-Hughes, A.; Huggett, A.C.; Domizio, P.; MacDonald, T.T.; Walker-Smith, J.A. Polymeric nutrition as the primary therapy in children with small bowel crohn’s disease. Aliment. Pharmacol. Ther. 1994, 8, 609–615. [Google Scholar] [CrossRef] [PubMed]
- Cameron, F.L.; Gerasimidis, K.; Papangelou, A.; Missiou, D.; Garrick, V.; Cardigan, T.; Buchanan, E.; Barclay, A.R.; McGrogan, P.; Russell, R.K. Clinical progress in the two years following a course of exclusive enteral nutrition in 109 paediatric patients with crohn’s disease. Aliment. Pharmacol. Ther. 2013, 37, 622–629. [Google Scholar] [CrossRef] [PubMed]
- Grogan, J.L.; Casson, D.H.; Terry, A.; Burdge, G.C.; El-Matary, W.; Dalzell, A.M. Enteral feeding therapy for newly diagnosed pediatric crohn’s disease: A double-blind randomized controlled trial with two years follow-up. Inflamm. Bowel Dis. 2012, 18, 246–253. [Google Scholar] [CrossRef] [PubMed]
- Connors, J.; Basseri, S.; Grant, A.; Giffin, N.; Mahdi, G.; Noble, A.; Rashid, M.; Otley, A.; Van Limbergen, J. Exclusive enteral nutrition therapy in paediatric crohn’s disease results in long-term avoidance of corticosteroids: Results of a propensity-score matched cohort analysis. J. Crohns Colitis 2017, 11, 1063–1070. [Google Scholar] [CrossRef] [PubMed]
- Grover, Z.; Burgess, C.; Muir, R.; Reilly, C.; Lewindon, P.J. Early mucosal healing with exclusive enteral nutrition is associated with improved outcomes in newly diagnosed children with luminal crohn’s disease. J. Crohns Colitis 2016, 10, 1159–1164. [Google Scholar] [CrossRef] [PubMed]
- Narula, N.; Dhillon, A.; Zhang, D.; Sherlock, M.E.; Tondeur, M.; Zachos, M. Enteral nutritional therapy for induction of remission in crohn’s disease. Cochrane Database Syst. Rev. 2018, 4, CD000542. [Google Scholar] [CrossRef] [PubMed]
- Yang, Q.; Gao, X.; Chen, H.; Li, M.; Wu, X.; Zhi, M.; Lan, P.; Hu, P. Efficacy of exclusive enteral nutrition in complicated crohn’s disease. Scand. J. Gastroenterol. 2017, 52, 995–1001. [Google Scholar] [CrossRef] [PubMed]
- Hu, D.; Ren, J.; Wang, G.; Li, G.; Liu, S.; Yan, D.; Gu, G.; Zhou, B.; Wu, X.; Chen, J.; et al. Exclusive enteral nutritional therapy can relieve inflammatory bowel stricture in crohn’s disease. J. Clin. Gastroenterol. 2014, 48, 790–795. [Google Scholar] [CrossRef] [PubMed]
- Present, D.H. Review article: The efficacy of infliximab in crohn’s disease--healing of fistulae. Aliment. Pharmacol. Ther. 1999, 13 (Suppl. 4), 23–28. [Google Scholar] [CrossRef] [PubMed]
- Takagi, S.; Utsunomiya, K.; Kuriyama, S.; Yokoyama, H.; Takahashi, S.; Iwabuchi, M.; Takahashi, H.; Takahashi, S.; Kinouchi, Y.; Hiwatashi, N.; et al. Effectiveness of an ‘half elemental diet’ as maintenance therapy for crohn’s disease: A randomized-controlled trial. Aliment. Pharmacol. Ther. 2006, 24, 1333–1340. [Google Scholar] [CrossRef] [PubMed]
- Verma, S.; Kirkwood, B.; Brown, S.; Giaffer, M.H. Oral nutritional supplementation is effective in the maintenance of remission in crohn’s disease. Dig. Liver Dis. 2000, 32, 769–774. [Google Scholar] [CrossRef]
- El-Matary, W.; Otley, A.; Critch, J.; Abou-Setta, A.M. Enteral feeding therapy for maintaining remission in crohn’s disease: A systematic review. J. Parenter. Enter. Nutr. 2017, 41, 550–561. [Google Scholar] [CrossRef] [PubMed]
- Tsertsvadze, A.; Gurung, T.; Court, R.; Clarke, A.; Sutcliffe, P. Clinical effectiveness and cost-effectiveness of elemental nutrition for the maintenance of remission in crohn’s disease: A systematic review and meta-analysis. Health Technol. Assess. 2015, 19, 1–138. [Google Scholar] [CrossRef] [PubMed]
- Takagi, S.; Utsunomiya, K.; Kuriyama, S.; Yokoyama, H.; Takahashi, S.; Umemura, K.; Iwabuchi, M.; Takahashi, H.; Takahashi, S.; Kinouchi, Y.; et al. Quality of life of patients and medical cost of “half elemental diet” as maintenance therapy for crohn’s disease: Secondary outcomes of a randomised controlled trial. Dig. Liver Dis. 2009, 41, 390–394. [Google Scholar] [CrossRef] [PubMed]
- Nguyen, D.L.; Palmer, L.B.; Nguyen, E.T.; McClave, S.A.; Martindale, R.G.; Bechtold, M.L. Specialized enteral nutrition therapy in crohn’s disease patients on maintenance infliximab therapy: A meta-analysis. Therap. Adv. Gastroenterol. 2015, 8, 168–175. [Google Scholar] [CrossRef] [PubMed]
- Yamamoto, T.; Shiraki, M.; Nakahigashi, M.; Umegae, S.; Matsumoto, K. Enteral nutrition to suppress postoperative crohn’s disease recurrence: A five-year prospective cohort study. Int. J. Colorectal Dis. 2013, 28, 335–340. [Google Scholar] [CrossRef] [PubMed]
- Heerasing, N.; Thompson, B.; Hendy, P.; Heap, G.A.; Walker, G.; Bethune, R.; Mansfield, S.; Calvert, C.; Kennedy, N.A.; Ahmad, T.; et al. Exclusive enteral nutrition provides an effective bridge to safer interval elective surgery for adults with crohn’s disease. Aliment. Pharmacol. Ther. 2017, 45, 660–669. [Google Scholar] [CrossRef] [PubMed]
- Russell, C.A. Role of dietitians in enteral feeding. Gut 1986, 27 (Suppl. 1), 58–60. [Google Scholar] [CrossRef] [PubMed]
© 2018 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
Share and Cite
Hansen, T.; Duerksen, D.R. Enteral Nutrition in the Management of Pediatric and Adult Crohn’s Disease. Nutrients 2018, 10, 537. https://doi.org/10.3390/nu10050537
Hansen T, Duerksen DR. Enteral Nutrition in the Management of Pediatric and Adult Crohn’s Disease. Nutrients. 2018; 10(5):537. https://doi.org/10.3390/nu10050537
Chicago/Turabian StyleHansen, Tawnya, and Donald R. Duerksen. 2018. "Enteral Nutrition in the Management of Pediatric and Adult Crohn’s Disease" Nutrients 10, no. 5: 537. https://doi.org/10.3390/nu10050537
APA StyleHansen, T., & Duerksen, D. R. (2018). Enteral Nutrition in the Management of Pediatric and Adult Crohn’s Disease. Nutrients, 10(5), 537. https://doi.org/10.3390/nu10050537