Use of exclusive enteral nutrition in adults with Crohn’s disease: A review

Abstract

Exclusive enteral nutrition (EEN) is well-established as a first line therapy instead of corticosteroid (CS) therapy to treat active Crohn’s disease (CD) in children. It also has been shown to have benefits over and above induction of disease remission in paediatric populations. However, other than in Japanese populations, this intervention is not routinely utilised in adults. To investigate potential reasons for variation in response between adult studies of EEN and CS therapy. The Ovid database was searched over a 6-mo period. Articles directly comparing EEN and CS therapy in adults were included. Eleven articles were identified. EEN therapy remission rates varied considerably. Poor compliance with EEN therapy due to unpalatable formula was an issue in half of the studies. Remission rates of studies that only included patients with previously untreated/new CD were higher than studies including patients with both existing and new disease. There was limited evidence to determine if disease location, duration of disease or age of diagnosis affected EEN therapy outcomes. There is some evidence to support the use of EEN as a treatment option for a select group of adults, namely those motivated to adhere to an EEN regimen and possibly those newly diagnosed with CD. In addition, the use of more palatable formulas could improve treatment compliance.

Keywords: Exclusive enteral nutrition; Crohn’s disease; Adults

Core tip: Exclusive enteral nutrition (EEN) is an established treatment for children with active Crohn’s disease (CD). At present, this therapy is used sparingly in adult patients outside of Japan. In reviewing the published literature regarding the use of EEN in adult patients, this article highlights evidence supporting the use of EEN as a treatment option for selected patients: namely those motivated to adhere to an EEN regimen and those newly diagnosed with CD. The role of EEN in adult patients with CD should now be re-examined, with particular regard to treatment protocols and the use of more palatable polymeric formulae that may enhance compliance.