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Nutrition therapy in Crohn’s disease
What is the role of nutrition therapy in CD?
Discuss the indications of EN in Crohn’s disease?
EN should be considered in adult patients with:
What are the chances of success with nutrition therapy?
What is the mechanism of action of nutrition therapy?
The mechanism of action is not known. The following mechanisms have been proposed:
One of the newer theories regarding the benefit of EN suggests that an anti-inflammatory effect on the GI mucosa may be related to specific fatty acids in diet or to the potential of defined enteral regimens to alter gut flora. There is now stronger evidence supporting the concept that enteral diet therapy for CD will result in histologic healing of the mucosa and down-regulation of mucosal pro inflammatory cytokines.
What is the role of elemental or polymeric formula to be used?
The optimal enteral formula is unknown. Initially elemental formulas were thought to be most likely to induce remission. Current evidence shows polymeric formulas are equally effective. Most trials investigating the role of the nitrogen source have confirmed that whole protein polymeric diets are equally as effective as elemental diets.
Findings from studies of fat composition have suggested that formulas with high concentrations of medium-chain triglycerides and low concentrations of long-chain triglycerides (LCTs) are associated with beneficial outcomes.
Discuss the role of nutrition therapy in maintaining remission?
Is TPN better than EN in the treatment of active Crohn’s disease?
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
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.
Discuss the reasons for the limited use of EN in the treatment of adult Crohn’s disease?
Limiting corticosteroid exposure, correcting the underlying malnutrition, and facilitating normal growth in the paediatric population are major advantages regarding EN. This does not hold true in adults. Other reasons for its limited use are:
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