Discuss nutrition as primary therapy for active CD?

• EN (ONS and Tube feeding- TF) is effective in the treatment of the acute phase of the disease and is considered the first line therapy in children.  The mechanism of beneficial effect of EN remains unclear.
• In adults, however, treatment with corticosteroids is more effective: therefore, in adults, EN as sole therapy for acute CD is indicated mainly when treatment with corticosteroids is not feasible, e.g. due to intolerance or refusal.
• The localisation of CD has no prognostic value for the response to EN. Approximately 60% of all patients reach remission.
• TPN is no better than EN in the therapy of active CD and should therefore be used only in patients with a contraindication to or intolerance of EN
• Compliance of patients receiving EN is low due to the unpalatability of the enteral formula or intolerance.

Discuss nutrition for maintenance of remission in CD?

• The length of remission and subsequent relapse rate after remission induced by EN are comparable to that after treatment with corticosteroids in children and adults.
• In longstanding (more than 1 year) clinical remission and in the absence of nutritional deficits, a benefit of EN has not been demonstrated.
• One-year relapse rates of active CD by EN are comparable to steroid therapy.

Discuss EN in CD?

• There are no significant differences in the effect of free amino acid, peptide-based and whole protein formulae for TF. Nutritional support with normal food is considered the treatment of choice.
• ONS can provide upto 600 Kcal/day in addition to normal food. If a higher intake is required, TF is necessary.
• TF can be safely delivered by a nasogastric tube (NGT) or percutaneous endoscopic gastrostomy (PEG).
• In some patients, who are intolerant to whole protein formulae AA or peptide-based formulae might however be tried.

Discuss nutrition in ulcerative colitis?

EN is not recommended as treatment of active UC.

Discuss parenteral nutrition in IBD?

• Although the faecal stream is likely to play a role in the pathogenesis of CD, there is no evidence that bowel rest combined with parenteral nutrition may be beneficial in refractory CD.
• There are no studies investigating the effect of drug treatment on nutritional status in UC. However, folic acid deficit may be related to sulphasalazine therapy.

Ref

1. ESPEN guidelines