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

Table 1 Studies of adults that compared exclusive enteral nutrition with corticosteroid therapy

Ref.	Year	Country	Age (SD or range)	Received no previous CD treatment (% of EEN group)	Number of participants		% that achieved remission (intention to treat)		Significant difference (P value)	Remission criteria	Number that did not complete EEN intervention, n (%)		% that achieved remission (treatment completed)
					EEN	CS	EEN	CS			Formula un-palatable	Other reason	EEN	CS
Engelman et al[19]	1993	England	23-54	Not stated	7	4	100%	100%	NS	HBI < 6.0	0 (0)	0	100%	100%
1Gassull et al[27]	2002	Europe	31.3 (3.3)	50%	20	19	20%	79%	0.0005	VHAI < 120	5 (25)	0	27%	79%
2Gassull et al[27]	2002	Europe	30.8 (4.1)	43.50%	23	19	52%	79%	NS	VHAI < 120	4 (17)	0	63%	79%
González-Huix et al[23]	1993	Spain	31.1 (4.1)	47%	15	17	8%	88%	NS	VHAI < 120	0 (0)	0	80%	88%
Gorard et al[21]	1993	England	31.6 (3.0)	50%	22	20	45%	85%	< 0.05	HBI - remission not defined , mean < 2	9 (41)	2	91%	89%
Lindor et al[25]	1992	United States	34.7 (26-64)	33%	9	10	50%	33%	NS	CDAI decrease > 100 points	3 (33)	1	60%	63%
Lochs et al[28]	1991	Europe	27.5 (1.5)	Not stated	55	52	53%	79%	< 0.01	CDAI decrease > 100 points or > 40%	7 (13)	0	60%	85%
Malchow et al[29]	1990	Europe	30.1 (11.5)	20%	51	44	41%	71%	< 0.05	CDAI decrease > 100 points or > 40%	20 (39)	0	71%	91%
Mantzaris et al[20]	1996	Greece	Not stated	20%	10	10	40%	70%	NS	CDAI < 150 or decrease > 100 points	0 (0)	0	40%	70%
Okada et al[26]	1990	Japan	21.0 (3.3)	100%	10	10	80%	30%	< 0.01	HBI < 1	0 (0)	0	80%	30%
O'Moráin et al[22]	1984	England	31.9 (15-60)	100%	11	10	82%	80%	NS	HBI - remission not defined. Mean < 3	2 (18)	0	100%	100%
Zoli et al[24]	1997	Italy	33.5 (15.9)	Not stated	12	10	67%	50%	NS	HBI < 3	1 (8)	1	80%	50%

^1,2Gassull et al had two EEN arms:

¹High oleic fatty acid formula;

²High linoleic fatty acid formula. CD: Crohn’s disease; CDAI: Crohn’s disease activity index; CS: Corticosteroids; EEN: Exclusive enteral nutrition; HBI: Harvey Bradshaw Index; NS: Non-significant; VHAI: Van Hees activity index.

Table 2 Characteristics of exclusive enteral nutrition regimens used in studies of adults that compared exclusive enteral nutrition with corticosteroid therapy

Ref.	Nutritional product	Type of feed	Duration of EEN (wk)	Calorie density (kcal/mL)	Nutritional composition (% TE)	Mode of delivery	Calorie intake per day
Engelman et al[19]	Peptamen	Peptide based elemental	2	1	Pro 16, CHO 51, Fat 33	Orally	30-35 kcal/kg per day
Gassull et al[27]	High oleic acid	Polymeric (powder)	4	1	Pro 22, CHO 46, Fat 32	Orally and NGT	Not stated
Gassull et al[27]	High linoleic acid	Polymeric (powder)	4	1	Pro 22, CHO 46, Fat 32	Orally and NGT	Not stated
González-Huix et al[23]	Edanec HN	Polymeric	4	1	Pro 22, CHO 46, Fat 32	NGT	Not stated
Gorard et al[21]	Vivonex TEN	Elemental	4	1	Pro 15, CHO 82, Fat 3	Orally, or NGT	2100 kcal per day
Lindor et al[25]	Vital HN	Peptide based elemental	4	1	Pro 17, CHO 74, Fat 9	Orally	40 kcal/kg per day
Lochs et al[28]	Peptisorb	Peptide based elemental	4-6	1	Pro 16, CHO 69, Fat 15	NGT or NDT	35 kcal/kg per day
Malchow et al[29]	Survimed	Peptide based elemental	3-6	1	Pro 14, CHO 76, Fat 10	Orally	33 kcal/kg per day
Mantzaris et al[20]	Nutrison HE	Polymeric	4	1.5	Pro 16, CHO 49, Fat 35	NDT	2250 kcal per day
Okada et al[26]	Elental	Elemental	6	1	Pro 19, CHO 81, Fat 1	NDT	40-60 kcal/kg per day
O'Moráin et al[22]	Vivonex	Elemental	4	1	Pro 15, CHO 82, Fat 3	Orally, or NGT	40-60 kcal/kg per day
Zoli et al[24]	Peptamen	Peptide based elemental	2	1	Pro 16, CHO 51, Fat 33	Orally	Not stated

CHO: Carbohydrate; EEN: Exclusive enteral nutrition; NDT: Nasoduodenal tube; NGT: Nasogastric tube; Pro: Protein; % TE: Percentage of total energy.