Background: Exclusive enteral nutrition (EEN) for 8–12 weeks, induces clinical remission in ∼70% of children and adolescents with active Crohn's disease (CD), and is considered comparable to steroids. We aimed to evaluate the impact of EEN in adults with active CD.
Methods: Patients with active CD, referred for nutritional intervention with EEN in a tertiary inflammatory bowel disease (IBD) center, were enrolled. Baseline weight and nutritional needs were recorded. EEN was administered by oral polymeric formula with no other food items allowed. Patients were treated for at least three weeks. Physician's Global Assessment (PGA), Harvey Bradshaw Index (HBI), biomarkers (blood count, C-reactive protein [CRP], and albumin), weight, and body mass index (BMI) were recorded at baseline and at the end of EEN course.
Results: A total of 33/42 patients with active CD (78%) who were offered EEN completed a full course. Eleven patients (33.3%) had newly diagnosed CD (<1.5 years), 16 (48.5%) were on stable-dose medications (immunomodulators and/or biologics), and two (6%) had no medical treatment. Disposition: male/female 25/8; mean age: 31.7±9.4 years; median disease duration – 7 (IQR 1–16) years. Montreal classification: L1 – 13 (39.4%), L2 – 1 (3%) L3 – 18 (54.5%); B1 – 15 (45.5%), B2 – 10 (30.3%), B3 – 4 (12.1%); P – 8 (24.2%). Baseline disease activity: PGA – mild 4, – moderate 20, and severe 8; mean HBI 6.7±4.7 points; median CRP 2.0 mg/dl (IQR 1.3–5.6). Mean EEN duration was 5.5 weeks (range 3–16). Baseline PGA improved after the EEN course in 31/33 patients (94%), this was in parallel to improvement in all activity indices: HBI 2.65±2.7 vs 6.78±4.7 vs (p<0.001); median CRP 1.01 (IQR 0.4–0.7) mg/dl vs 2 (IQR 1.3–5.6) vs mg/dl (p<0.001); mean albumin 4.2±0.4 mg/l vs 3.8±0.6 mg/l (p=0.003), respectively. There was no change in weight or BMI during EEN therapy. Notably, activity indices were also improved in a subgroup of long standing- CD patients: decrease in HBI 7.3±5.08 to 3.0±3.4 (p<0.001); CRP 4.66±5.7 mg/dl to 1.08±1.5 mg/dl (p=0.005). Finally, in 16 patients who received EEN as an add- on therapy to stable doses of their baseline therapy, HBI decreased from 6.5±5.8 to 2.4±3.3 (p=0.001) and CRP dropped from 3.5 (IQR 0.98–3.6) mg/dl to 0.88 (IQR 0.36–0.6)mg/dl (p=0.023).
Conclusions: EEN is an effective therapeutic modality for active CD in adults. EEN therapy is associated with decreased clinical and biologic inflammatory activity, and may benefit patients with longstanding and newly diagnosed CD in need of a bridge or an add-on induction treatment.