Skip to main content
Top
Published in: International Journal of Colorectal Disease 1/2016

01-01-2016 | Review

Enteral nutrition for maintaining remission in patients with quiescent Crohn’s disease: current status and future perspectives

Authors: Maki Nakahigashi, Takayuki Yamamoto, Rodolfo Sacco, Hiroyuki Hanai, Fumio Kobayashi

Published in: International Journal of Colorectal Disease | Issue 1/2016

Login to get access

ABSTRACT

Purpose

The value of enteral nutrition (EN) as maintenance therapy in patients with quiescent Crohn’s disease (CD) has not been fully evaluated. The purpose of this study was to review the efficacy of EN for the maintenance of remission in patients with quiescent CD.

Methods

Seven prospective cohort studies evaluating the efficacy of EN for the maintenance of remission in quiescent CD were included. Three of the seven studies were randomized-controlled trials (RCTs). In all studies, patients used EN as a supplement or as a nocturnal tube feeding in addition to their normal food.

Results

One study compared the efficacy of elemental diet and polymeric diet. Elemental and polymeric diets were equally effective for the maintenance of clinical remission and for allowing tapering and cessation of steroid therapy. The other six studies compared the outcomes between patients treated with and without EN. The maintained clinical remission rate at 1 year was significantly higher in patients treated with EN in four of the six studies. Quantitative pooling of the studies was not feasible due to a small number of RCTs and a narrative account of the study characteristics.

Conclusions

Our review suggests that EN is useful for the maintenance of remission in patients with quiescent CD. However, there are several limitations in the reviewed studies. There are few RCTs. Further, the sample size is small, and the duration of intervention and follow-up is short. Large and well-designed RCTs should be conducted to rigorously evaluate the efficacy of EN for maintaining remission.
Literature
1.
go back to reference O’Sullivan M, O’Morain C (2006) Nutrition in inflammatory bowel disease. Best Pract Res Clin Gastroenterol 20:561–573PubMedCrossRef O’Sullivan M, O’Morain C (2006) Nutrition in inflammatory bowel disease. Best Pract Res Clin Gastroenterol 20:561–573PubMedCrossRef
2.
go back to reference Razack R, Seidner DL (2007) Nutrition in inflammatory bowel disease. Curr Opin Gastroenterol 23:400–405PubMedCrossRef Razack R, Seidner DL (2007) Nutrition in inflammatory bowel disease. Curr Opin Gastroenterol 23:400–405PubMedCrossRef
3.
go back to reference Mekhjian HS, Switz DM, Melnyk CS, Rankin GB, Brooks RK (1979) Clinical features and natural history of Crohn’s disease. Gastroenterology 77:898–906PubMed Mekhjian HS, Switz DM, Melnyk CS, Rankin GB, Brooks RK (1979) Clinical features and natural history of Crohn’s disease. Gastroenterology 77:898–906PubMed
4.
go back to reference Hodges P, Gee M, Grace M, Sherbaniuk RW, Wensel RH, Thomson AB (1984) Protein-energy intake and malnutrition in Crohn’s disease. J Am Diet Assoc 84:1460–1464PubMed Hodges P, Gee M, Grace M, Sherbaniuk RW, Wensel RH, Thomson AB (1984) Protein-energy intake and malnutrition in Crohn’s disease. J Am Diet Assoc 84:1460–1464PubMed
5.
go back to reference Yamamoto T, Nakahigashi M, Saniabadi AR (2009) Review article: diet and inflammatory bowel disease—epidemiology and treatment. Aliment Pharmacol Ther 30:99–112PubMedCrossRef Yamamoto T, Nakahigashi M, Saniabadi AR (2009) Review article: diet and inflammatory bowel disease—epidemiology and treatment. Aliment Pharmacol Ther 30:99–112PubMedCrossRef
6.
go back to reference Zachos M, Tondeur M, Griffiths AM (2007) Enteral nutritional therapy for induction of remission in Crohn’s disease. Cochrane Database Syst Rev 1, CD000542PubMed Zachos M, Tondeur M, Griffiths AM (2007) Enteral nutritional therapy for induction of remission in Crohn’s disease. Cochrane Database Syst Rev 1, CD000542PubMed
7.
go back to reference Dziechciarz P, Horvath A, Shamir R, Szajewska H (2007) Meta-analysis: enteral nutrition in active Crohn’s disease in children. Aliment Pharmacol Ther 26:795–806PubMedCrossRef Dziechciarz P, Horvath A, Shamir R, Szajewska H (2007) Meta-analysis: enteral nutrition in active Crohn’s disease in children. Aliment Pharmacol Ther 26:795–806PubMedCrossRef
8.
go back to reference Lochs H, Dejong C, Hammarqvist F, Hebuterne X, Leon-Sanz M, Schütz T, van Gemert W, van Gossum A, Valentini L, DGEM (German Society for Nutritional Medicine), Lübke H, Bischoff S, Engelmann N, Thul P, ESPEN (European Society for Parenteral and Enteral Nutrition) (2006) ESPEN guidelines on enteral nutrition: gastroenterology. Clin Nutr 25:260–274PubMedCrossRef Lochs H, Dejong C, Hammarqvist F, Hebuterne X, Leon-Sanz M, Schütz T, van Gemert W, van Gossum A, Valentini L, DGEM (German Society for Nutritional Medicine), Lübke H, Bischoff S, Engelmann N, Thul P, ESPEN (European Society for Parenteral and Enteral Nutrition) (2006) ESPEN guidelines on enteral nutrition: gastroenterology. Clin Nutr 25:260–274PubMedCrossRef
9.
go back to reference Verma S, Kirkwood B, Brown S, Giaffer MH (2000) Oral nutritional supplementation is effective in the maintenance of remission in Crohn’s disease. Dig Liver Dis 32:769–774PubMedCrossRef Verma S, Kirkwood B, Brown S, Giaffer MH (2000) Oral nutritional supplementation is effective in the maintenance of remission in Crohn’s disease. Dig Liver Dis 32:769–774PubMedCrossRef
10.
go back to reference Verma S, Holdsworth CD, Giaffer MH (2001) Does adjuvant nutritional support diminish steroid dependency in Crohn disease? Scand J Gastroenterol 36:383–388PubMedCrossRef Verma S, Holdsworth CD, Giaffer MH (2001) Does adjuvant nutritional support diminish steroid dependency in Crohn disease? Scand J Gastroenterol 36:383–388PubMedCrossRef
11.
go back to reference Takagi S, Utsunomiya K, Kuriyama S, Yokoyama H, Takahashi S, Iwabuchi M, Takahashi H, Takahashi S, Kinouchi Y, Hiwatashi N, Funayama Y, Sasaki I, Tsuji I, Shimosegawa T (2006) Effectiveness of an ‘half elemental diet’ as maintenance therapy for Crohn’s disease: a randomized-controlled trial. Aliment Pharmacol Ther 24:1333–1340PubMedCrossRef Takagi S, Utsunomiya K, Kuriyama S, Yokoyama H, Takahashi S, Iwabuchi M, Takahashi H, Takahashi S, Kinouchi Y, Hiwatashi N, Funayama Y, Sasaki I, Tsuji I, Shimosegawa T (2006) Effectiveness of an ‘half elemental diet’ as maintenance therapy for Crohn’s disease: a randomized-controlled trial. Aliment Pharmacol Ther 24:1333–1340PubMedCrossRef
12.
go back to reference Yamamoto T, Nakahigashi M, Saniabadi AR, Iwata T, Maruyama Y, Umegae S, Matsumoto K (2007) Impacts of long-term enteral nutrition on clinical and endoscopic disease activities and mucosal cytokines during remission in patients with Crohn’s disease: a prospective study. Inflamm Bowel Dis 13:1493–1501PubMedCrossRef Yamamoto T, Nakahigashi M, Saniabadi AR, Iwata T, Maruyama Y, Umegae S, Matsumoto K (2007) Impacts of long-term enteral nutrition on clinical and endoscopic disease activities and mucosal cytokines during remission in patients with Crohn’s disease: a prospective study. Inflamm Bowel Dis 13:1493–1501PubMedCrossRef
13.
go back to reference Yamamoto T, Nakahigashi M, Umegae S, Kitagawa T, Matsumoto K (2007) Impact of long-term enteral nutrition on clinical and endoscopic recurrence after resection for Crohn’s disease: a prospective, non-randomized, parallel, controlled study. Aliment Pharmacol Ther 25:67–72PubMedCrossRef Yamamoto T, Nakahigashi M, Umegae S, Kitagawa T, Matsumoto K (2007) Impact of long-term enteral nutrition on clinical and endoscopic recurrence after resection for Crohn’s disease: a prospective, non-randomized, parallel, controlled study. Aliment Pharmacol Ther 25:67–72PubMedCrossRef
14.
go back to reference Yamamoto T, Nakahigashi M, Umegae S, Matsumoto K (2010) Prospective clinical trial: enteral nutrition during maintenance infliximab in Crohn’s disease. J Gastroenterol 45:24–29PubMedCrossRef Yamamoto T, Nakahigashi M, Umegae S, Matsumoto K (2010) Prospective clinical trial: enteral nutrition during maintenance infliximab in Crohn’s disease. J Gastroenterol 45:24–29PubMedCrossRef
15.
go back to reference Hanai H, Iida T, Takeuchi K, Arai H, Arai O, Abe J, Tanaka T, Maruyama Y, Ikeya K, Sugimoto K, Nakamura T, Nakamura K, Watanabe F (2012) Nutritional therapy versus 6-mercaptopurine as maintenance therapy in patients with Crohn’s disease. Dig Liver Dis 44:649–654PubMedCrossRef Hanai H, Iida T, Takeuchi K, Arai H, Arai O, Abe J, Tanaka T, Maruyama Y, Ikeya K, Sugimoto K, Nakamura T, Nakamura K, Watanabe F (2012) Nutritional therapy versus 6-mercaptopurine as maintenance therapy in patients with Crohn’s disease. Dig Liver Dis 44:649–654PubMedCrossRef
16.
go back to reference Best WR, Becktel JM, Singleton JW, Kern F Jr (1976) Development of a Crohn’s disease activity index. National Cooperative Crohn’s Dis Study Gastroenterol 70:439–444 Best WR, Becktel JM, Singleton JW, Kern F Jr (1976) Development of a Crohn’s disease activity index. National Cooperative Crohn’s Dis Study Gastroenterol 70:439–444
17.
go back to reference Wardle TD, Hall L, Turnberg LA (1992) Use of coculture of colonic mucosal biopsies to investigate the release of eicosanoids by inflamed and uninflamed mucosa from patients with inflammatory bowel disease. Gut 33:1644–1651PubMedPubMedCentralCrossRef Wardle TD, Hall L, Turnberg LA (1992) Use of coculture of colonic mucosal biopsies to investigate the release of eicosanoids by inflamed and uninflamed mucosa from patients with inflammatory bowel disease. Gut 33:1644–1651PubMedPubMedCentralCrossRef
18.
go back to reference Rutgeerts P, Geboes K, Vantrappen G, Beyls J, Kerremans R, Hiele M (1990) Predictability of the postoperative course of Crohn’s disease. Gastroenterology 99:956–963PubMed Rutgeerts P, Geboes K, Vantrappen G, Beyls J, Kerremans R, Hiele M (1990) Predictability of the postoperative course of Crohn’s disease. Gastroenterology 99:956–963PubMed
19.
go back to reference Yamamoto T, Shiraki M, Nakahigashi M, Umegae S, Matsumoto K (2013) Enteral nutrition to suppress postoperative Crohn’s disease recurrence: a five-year prospective cohort study. Int J Color Dis 28:335–340CrossRef Yamamoto T, Shiraki M, Nakahigashi M, Umegae S, Matsumoto K (2013) Enteral nutrition to suppress postoperative Crohn’s disease recurrence: a five-year prospective cohort study. Int J Color Dis 28:335–340CrossRef
20.
go back to reference Hirakawa H, Fukuda Y, Tanida N, Hosomi M, Shimoyama T (1993) Home elemental enteral hyperalimentation (HEEH) for the maintenance of remission in patients with Crohn’s disease. Gastroenterol Jpn 28:379–384PubMed Hirakawa H, Fukuda Y, Tanida N, Hosomi M, Shimoyama T (1993) Home elemental enteral hyperalimentation (HEEH) for the maintenance of remission in patients with Crohn’s disease. Gastroenterol Jpn 28:379–384PubMed
21.
go back to reference Esaki M, Matsumoto T, Nakamura S, Yada S, Fujisawa K, Jo Y, Iida M (2006) Factors affecting recurrence in patients with Crohn’s disease under nutritional therapy. Dis Colon Rectum 49(10 Suppl):S68–S74PubMedCrossRef Esaki M, Matsumoto T, Nakamura S, Yada S, Fujisawa K, Jo Y, Iida M (2006) Factors affecting recurrence in patients with Crohn’s disease under nutritional therapy. Dis Colon Rectum 49(10 Suppl):S68–S74PubMedCrossRef
22.
go back to reference Sanderson IR, Boulton P, Menzies I, Walker-Smith JA (1987) Improvement of abnormal lactulose/rhamnose permeability in active Crohn’s disease of the small bowel by an elemental diet. Gut 28:1073–1076PubMedPubMedCentralCrossRef Sanderson IR, Boulton P, Menzies I, Walker-Smith JA (1987) Improvement of abnormal lactulose/rhamnose permeability in active Crohn’s disease of the small bowel by an elemental diet. Gut 28:1073–1076PubMedPubMedCentralCrossRef
23.
go back to reference Fell JM, Paintin M, Arnaud-Battandier F, Beattie RM, Hollis A, Kitching P, Donnet-Hughes A, MacDonald TT, Walker-Smith JA (2000) 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 14:281–289PubMedCrossRef Fell JM, Paintin M, Arnaud-Battandier F, Beattie RM, Hollis A, Kitching P, Donnet-Hughes A, MacDonald TT, Walker-Smith JA (2000) 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 14:281–289PubMedCrossRef
Metadata
Title
Enteral nutrition for maintaining remission in patients with quiescent Crohn’s disease: current status and future perspectives
Authors
Maki Nakahigashi
Takayuki Yamamoto
Rodolfo Sacco
Hiroyuki Hanai
Fumio Kobayashi
Publication date
01-01-2016
Publisher
Springer Berlin Heidelberg
Published in
International Journal of Colorectal Disease / Issue 1/2016
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-015-2348-x

Other articles of this Issue 1/2016

International Journal of Colorectal Disease 1/2016 Go to the issue