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Nutrition in IBD

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



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