Enteral nutrition for maintenance of remission in Crohn's disease
Published Online: 18 JUL 2007
Assessed as up-to-date: 29 APR 2007
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Akobeng AK, Thomas AG. Enteral nutrition for maintenance of remission in Crohn's disease. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD005984. DOI: 10.1002/14651858.CD005984.pub2.
- Publication Status: Edited (no change to conclusions)
- Published Online: 18 JUL 2007
Prevention of relapse is a major issue in the management of Crohn's disease. Corticosteroids and 5-ASA preparations are not effective for the maintenance of remission. Methotrexate, infliximab, 6-mercaptopurine and its prodrug, azathioprine may be effective in maintaining remission, but these drugs may cause significant adverse events.
To conduct a systematic review to evaluate the efficacy of enteral nutrition for the maintenance of remission in Crohn's disease.
MEDLINE (1966 to January 2007), EMBASE (1984 to January 2007) the Cochrane Central Register of Controlled Trials from the Cochrane Library (Issue 4, 2006) and the IBD/FBD Review Group Specialized Trials Register were searched. The articles cited in each publication were hand searched.
Randomised controlled trials which compared enteral nutrition with no intervention, placebo or with any other intervention were eligible for inclusion.
Data collection and analysis
Data extraction and assessment of methodological quality of included studies were independently performed by two authors. The main outcome measure was the occurrence of clinical or endoscopic relapse as defined by the primary studies. Odds ratios and 95% confidence intervals were calculated for dichotomous outcomes.
Two studies were identified that met the inclusion criteria and were included in the review. Statistical pooling of the results of these studies was not possible because the control interventions, and the way outcomes were assessed differed greatly between the two studies. In one study (Takagi 2006), patients who received half of their total daily calorie requirements as elemental diet and the remaining half by normal diet had a significantly lower relapse rate compared to patients who received unrestricted normal diet (9 of 26 versus 16 of 25; OR 0.3, 95% CI 0.09 to 0.94). In the other study (Verma 2001), elemental and polymeric feeds (providing between 35 and 50% of patients' pretrial calorie intake in addition to unrestricted normal food) were equally effective for maintenance of remission and allowing withdrawal of steroid therapy (8 of 19 versus 6 of 14; OR 0.97, 95% CI 0.24 to 3.92).
The available evidence suggests that supplementary enteral nutritional may be effective for maintenance of remission in Crohn's disease. Whilst larger studies are needed to confirm these findings, enteral nutritional supplementation could be considered as an alternative or as an adjunct to maintenance drug therapy in Crohn's disease.
Plain language summary
Enteral nutrition (liquid feeds) for maintenance of remission in Crohn's disease
Crohn's disease is a chronic inflammatory disease of the intestines. Crohn's disease frequently occurs in the lower part of the small intestine (the ileum), however it can affect any part of the digestive tract, from the mouth to the anus. The most common symptoms of Crohn's disease are abdominal pain, often in the lower right region of the abdomen, and diarrhea. The mechanism by which enteral nutrition may influence inflammation is unknown and is currently being studied. Two small studies were reviewed. The studies tested the effectiveness of enteral nutrition as maintenance therapy among 84 adult patients whose Crohn's disease was in remission. In one study the subjects received half the amount of their daily allowance of calories as enteral nutrition and the remaining half by normal diet. The comparison group followed a normal diet. The other study compared an elemental versus liquid diet to a polymeric formulation. The study that compared enteral nutrition with a normal diet found that enteral nutrition was an effective strategy for reducing the rate of relapse. The other study found that there was no difference in effectiveness between elemental and polymeric formulas. However, both studies were small and no firm conclusions can be made regarding the effectiveness of enteral nutrition. Enteral nutrition appears to be safe. Neither study reported any side effects that were related to enteral nutrition. The current evidence suggests that supplementary enteral nutrition (liquid feeds) may be effective for maintenance of remission in Crohn's disease.
搜尋MEDLINE (1966年–2007年1月), EMBASE (1984年–2007年1月) Cochrane Central Register of Controlled Trials from Cochrane Library (Issue 4, 2006年)以及IBD/FBD Review Group Specialized Trials Register。並人工搜尋每篇發表文章的參考文獻。
找到2個研究符合標準並且被納入本文獻回顧中，但這2個研究之間因為所選用的對照介入治療和評估治療成果的方法都大不相同，所以並無法將這兩個試驗的結果以統計學的角度加以合併。 其中一個試驗(Takagi，2006)顯示，相對於提供未限制的正常飲食給病患的的組別來說，將病患每日所需熱量的一半以元素飲食(elemental diet)供應、另一半以正常飲食(normal diet)方式供應給病患，可以明顯降低克隆氏症的復發率(26人有9人復發和25人有16人復發，勝算比為0.3，95%CI介於0.09至0.94間)。 另一研究中(Verma，2001)顯示，給予病患元素飲食和聚合飲食（polymeric diet）(在未限制的正常飲食外，額外給予病患受試前飲食攝取的35∼50%的熱量)對於維持緩解效果的功效相同，並可以終止類固醇治療(19人有8人終止和14人有6人終止，OR值為0.97，95%CI介於0.24至3.92間)。