Exclusive enteral nutrition (EEN) is a well-establised primary therapy in active pediatric Crohn’s disease (CD). EEN promotes mucosal healing, restores bone mineral density, and improves growth. On the contrary, treatment of active CD with corticosteroids (CS) has a strong negative impact on the linear growth and bone density. Therefore, EEN is recommended as a first-line therapy in children with active CD. EEN has been evaluated in a number of clinical studies including randomized controlled trials. While meta-analyses of adult studies suggest superiority of CS, pediatric studies have shown that EEN is at least as effective as CS in inducing remission. The mechanisms by which EEN suppresses inflammation are not yet fully elucidated. Hypotheses include improvement in nutritional status, decreasing of the inflammatory cascade mechanism, limiting luminal antigen exposure, improving intestinal permeability, and modification of intestinal microbiota.
Part of the book: New Concepts in Inflammatory Bowel Disease
Exclusive enteral nutrition (EEN) has proven to be a highly effective treatment option in inducing remission in active Crohn’s disease (CD) in the paediatric population. In adults with CD, the results of meta-analyses demonstrated that therapy with corticosteroids was more effective in comparison with EEN. The most important limitation of the success of EEN treatment is patients’ compliance. Exclusivity of enteral nutrition and its substantial impact on the quality of life are the main reasons why EEN is not acceptable to many patients. Therefore, the treatment with partial enteral nutrition (PEN), where patients are allowed to eat some ordinary food besides enteral formulas, is becoming an important treatment option, not only in inducing, but also in maintaining remission in CD. However, strong evidence on the efficacy of PEN for induction and maintenance of CD remission is still lacking. Due to the excellent safety profile of the treatment with enteral nutrition in comparison with other treatment modalities, further well-designed, randomised, controlled studies are necessary to elucidate the exact role of PEN in inducing and maintaining of remission in CD patients. Herein, the most relevant studies on the efficacy and the role of PEN in active and quiescent CD are reviewed.
Part of the book: Crohn’s Disease