Analysis Of Different Effects Of Exclusive Enteral Nutrition On Colonic And Non-Colonic Crohn’s Disease Patients

Background & aims:Crohn’s disease(CD)is a chronic non-specific intestinal inflammatory disease with many complications and high disability rate.Exclusive enteral nutrition(EEN)as a primary therapy is safe and effective for inducing clinical remission of active luminal CD.Whether isolated colonic involvement affects the efficacy of EEN is controversial.We aimed to identify the difference of response between isolated colonic and noncolonic CD on EEN and to determine potential predictors of the response to induction therapy with EEN in adult patients with CD.Methods:Data for adult CD patients treated with EEN as an induction therapy at our center from January 1,2014,to May 31,2017,were reviewed.Eligible patients were divided into isolated colonic Crohn’s disease(c CD)group and non-colonic Crohn’s disease(nonc CD)group according to the disease location.The rates of clinical remission,serum inflammatory and nutritional markers were compared between the groups.Possible relationships between isolated colonic involvement or other potential factors and the efficacy of EEN were assessed by univariate and multivariate analyses.The propensity score matching method was used to confirm the results.Results:Overall,241 patients were included in the analysis: 52 patients in the c CD group and189 patients in the non-c CD group.The rates of clinical remission differed between the two groups(c CD group: 51.9% VS.non-c CD group: 68.3%,p=0.029).Multivariate analyses indicated that isolated colonic involvement was associated with a reduced response to EEN(OR=2.74;95%CI: [1.2-6.23],p= 0.016).Additionally,the lean body mass index(LBMI)before treatment was associated with the efficacy of EEN(OR=0.636;95%CI=[0.444-0.912],p=0.014).These associations were confirmed using the propensity score model.For patients with isolated colonic CD,multivariate analysis showed that pancolitis(OR = 16.7;95%CI=[1.074-260.5],p=0.044)was another independent factor influencing the efficacy of EEN.Conclusions:Isolated colonic CD showed a reduced response to induction therapy with EEN compared with ileal or ileocolonic disease in adult patients.Besides,we identified that pretreatment CRP levels,low LBMI are factors influencing the response to EEN in CD patients.