Intervention Review

Enteral nutrition for maintenance of remission in Crohn's disease

  1. Anthony K Akobeng1,*,
  2. Adrian G Thomas2

Editorial Group: Cochrane Inflammatory Bowel Disease and Functional Bowel Disorders Group

Published Online: 18 JUL 2007

Assessed as up-to-date: 29 APR 2007

DOI: 10.1002/14651858.CD005984.pub2


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.

Author Information

  1. 1

    Royal Manchester Children's Hospital, Manchester, UK

  2. 2

    Booth Hall Childrens Hospital, Manchester, UK

*Anthony K Akobeng, Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, UK. akobeng@aol.com. anthony.akobeng@cmft.nhs.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 18 JUL 2007

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要

Background

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.

Objectives

To conduct a systematic review to evaluate the efficacy of enteral nutrition for the maintenance of remission in Crohn's disease.

Search methods

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.

Selection criteria

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.

Main results

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).

Authors' conclusions

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

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要

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.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要

利用腸道營養(Enteral nutrition)來維持克隆氏症的緩解效果

研究背景

在克隆氏症的治療上,預防復發是一個很重要的議題,糖皮質類固醇和五胺基水楊酸(5Aminosalicylic acid,5ASA)製劑並沒有維持緩解效果的功效,Methotrexate、infliximab和6mercaptopurine和其前驅藥物azathioprine則可能有助於維持緩解的效果,但是這些藥物可能產生明顯的不良事件。

研究目的

整合出一份系統性的文獻回顧以評估腸道營養對於維持克隆氏症緩解效果的功效。

检索策略

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。

标准/纳入排除标准

比較腸道營養和沒有進行介入治療、安慰劑或其他介入治療的隨機對照試驗都會被納入文獻回顧。

数据收集与分析

由兩位作者獨立針對所納入的研究摘錄其數據並且評估研究方法的品質。主要的治療成果評估項目包括由早期研究所界定的臨床或內視鏡復發症狀。對於二元性成果則計算勝算比(Odds ratios)和95%CI。

主要结果

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)。

作者结论

藉由有用的證據可以推測補充腸道營養可能可以維持克隆氏症緩解,雖然仍必須要進行一些大型研究來確認這個發現,但是仍可將補充腸道營養這個方法視為克隆氏症的一個替代性或輔助藥物治療性的治療方法。

 

概要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要

腸道營養(液態餵食)可能是一種對於克隆氏症維持緩解治療有效的方法,但是腸道營養可以治療克隆氏症或是具有安全性嗎?本研究已針對兩個研究進行文獻回顧,這些研究以84名成年的克隆氏症已經獲得緩解的病患為對象,探討以腸道營養作為維持治療的功效,在其中一個研究中,受試者每日所需熱量的一半係以腸道營養方式供給,另一半則為正常進食,比較組則完全進行正常進食;另一個研究中則是比較元素飲食和聚合配方的液態進食。甚麼是克隆氏症?而腸道營養可以發揮功效嗎?克隆氏症是一種腸道的慢性發炎疾病,並且好發於下半部的小腸腸道(迴腸),但是實際上克隆氏症有可能發作於由口腔至肛門所構成整體消化道的任意部位中,克隆氏症最常見的病徵是腹部疼痛,通常是腹部右下方的疼痛,還有腹瀉症狀。目前還不瞭解腸道營養對於發炎反應的影響機制,但腸道營養近來卻廣受研究。這些研究顯示出甚麼結果?將腸道營養和正常飲食進行比較的研究發現,腸道營養對於降低復發率是一個相當有用的策略,另一個研究則發現元素配方和聚合配方並不會產生不同的效果,但是這兩個研究規模都較小且並沒有做出確認性的結論說明腸道營養的效果。腸道營養的安全性有多高?目前的研究顯示腸道營養是安全的,兩個研究都沒有提出與腸道營養有關的副作用。最後,底線是甚麼?近來的證據顯示補充腸道營養(液體餵食)可能對於維持克隆氏症的緩解效果具有效用。

翻译注解