Background: Exclusive enteral nutrition (EEN) is commonly used to induce disease remission in children, but not adults, with active Crohn's disease. Partial enteral nutrition (PEN) has been shown to improve symptoms in children and adolescents but is inferior to EEN in achieving mucosal healing. The aim of this study was to investigate the feasibility and effectiveness of EEN and a novel PEN regimen to achieve disease remission in young adults with active Crohn's disease.
Methods: Adults aged 16–40 years with active Crohn's disease involving the ileum were referred into an open label prospective intervention study comprising of two interventions: eight weeks of EEN or PEN with a polymeric formula. The PEN regimen comprised of two weeks of EEN followed by six weeks of enteral nutrition plus one small meal per day of usual foods. Patients had serum, faecal and anthropometric assessments at baseline and fortnightly during treatment. Disease activity was assessed at baseline and treatment completion using the Crohn's disease activity index.
Results: Patients referred for treatment with EEN (n=25) or PEN (n=13) had similar baseline characteristics. Fourteen patients (56%) completed EEN and nine (69%) completed PEN treatment. Patients withdrew from the study for various reasons. Intention to treat and per protocol analysis found that disease activity significantly reduced consequent to both treatments (p<0.03). Disease remission was achieved by 93% and 78% of patients who completed treatment with EEN and PEN respectively (p>0.05). Per protocol analysis found that median serum C-reactive protein decreased in both groups (p=0.09) and median insulin-like growth factor-1 improved consequent to EEN (p=0.048) and PEN (p=0.20). Body mass index decreased during EEN (p=0.008) and PEN treatment (p=0.152). Faecal calprotectin fell in the EEN group to a median of 587 μg/g (micrograms per gram) (p=0.091) and in the PEN group to a median of 773 μg/g (micrograms per gram) (p=0.910).
Conclusions: EEN and PEN effectively induce disease remission in young adults with small bowel Crohn's disease and a novel PEN treatment may be a feasible alternative treatment in this cohort. PEN treatments should be explored further in a larger cohort of adults with active small bowel Crohn's disease but the impact of the inclusion of usual foods on mucosal healing needs to be assessed.