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Partial enteral nutrition is unlikely to suppress inflammation and so treat active Crohn’s disease
Enteral nutrition is an effective therapy for active Crohn’s disease (CD) although less effective than steroids. This has been shown in a number of original studies and meta-analyses.1,2 Enteral nutrition leads to remission in approximately 60% of patients within 4–6 weeks. Unfortunately, enteral nutrition has never been compared with placebo or other medical therapies such as mesalamine or topical steroids. With the lack of such studies demonstrating that enteral nutrition is superior to placebo, the question has been raised if enteral nutrition has any therapeutic effect at all. However, remission rates with enteral nutrition range from 53% to 80%, which is higher than remission rates of placebo groups in most studies, which range from 18% to 40%. Therefore, a direct anti-inflammatory effect of enteral nutrition in active CD is generally accepted. The therapeutic efficacy of enteral nutrition in active CD is also suggested by results of recent studies demonstrating mucosal healing as well as a reduction in proinflammatory cytokines3,4 by enteral nutrition. The effect of enteral nutrition appears to be similar if the diet is drunk or applied via a tube and is also comparable with the effect of parenteral nutrition. Specific compositions of enteral diets—elemental diets or diets containing specific components—have no advantage over standard polymeric diets.1,5–7
In adults, enteral nutrition is rarely used as the sole therapy for active CD in clinical practice. This is partly due to its inferiority compared with steroids and partly to the inconvenience of enteral nutrition, resulting in low patient compliance—specifically if the mostly unpalatable diets are drunk. This appears to be different in children, who accept enteral nutrition much better, with compliance rates …
Conflict of interest: None declared.
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