Oral Exclusive Enteral Nutritional Therapy Accelerates The Induction Of Remission In Patients With Active Crohn’s Disease

Background:Crohn’s disease(CD)is a chronic inflammatory disease of the digestive tract,its etiology and pathogenesis are still unclear.The incidence of CD is increasing,and it has many complications and high disability rate.Therefore,the treatment of CD has attracted more and more attention all over the world.Malnutrition is one of the most common systemic manifestations of CD patients,and nutritional therapy,especially enteral nutrition(EN),is significant for CD patients.The administration route includes tube feeding and oral feeding.It’s considered that the clinical effect of tube feeding is better than oral feeding.But tube feeding has side effects and cost much.Therefore,it’s worthy to explore the efficacy of exclusive enteral nutrition(EEN)treated by improved oral method.Objective:To investigate the effects of enteral nutrition therapy by improved oral method in the induction of remission by IFX and AZA in adult patients with active CD.Method:Patients with active CD who met the inclusion criteria,hospitalized in Nanfang hospital from December 2012 to December 2019 were reviewed.They were divided into two group:control group which were only given IFX and AZA,and experimental group which were given IFX,AZA combined with EN.According to different enteral nutritional treatment regimens,the experimental group was further divided into EEN group and PEN group,these patients were treated with enteral nutritional therapy(Ensure)by improved oral method.The improved oral method of enteral nutritional therapy was to add enteral nutritional powder to hot water to make up one cup(300ml)following the instructions,place it into a vacuum bottle,and then drink 15-30ml every 3 minutes to ensure the enteral nutrition enters the digestive tract slowly and continuously.The course of oral enteral nutrition treatment was 4 weeks.Comparative analyses of body mass index(BMI),the Crohn’s Disease Activity Index(CDAI),the Nutritional Risk Screening(NRS-2002),white blood cell count(WBC),the percent of neutrophile granulocyte(NEU%),hemoglobin(HGB),platelet count(PLT),C-reactive protein(CRP),albumin(ALB)and remission rates were performed at weeks 0,2,6 and 14.Results:A total of 36 patients met the inclusion criteria and were included,including 11 patients in the control group,14 patients in the PEN group and 11 patients in the EEN group.In terms of disease activity,the decline of CDAI in EEN group was the most obvious at weeks 2,6 and 14,PEN group and control group decreased successively.The difference between EEN group and control group at weeks 2 and 6 were statistically significant(P<0.05),while there was no significant difference between PEN group and control group(P>0.05).At week 6,the clinical remission rate of EEN group was 100%(11/11),higher than that of PEN group(78.6%,11/14)and control group(63.6%,7/11),the difference between EEN group and control group was statistically significant(P<0.05).At week 14,the clinical remission rate of EEN group was 90.9%(10/11),higher than that of PEN group(85.7%,12/14)and control group(63.6%,7/11),but there was no significant difference among the three groups(P>0.05).In terms of nutritional indicators,the increase of BMI in EEN group were the most obvious at weeks 2,6 and 14,PEN group and control group decreased successively.The difference between EEN group and control group at week 2 was statistically significant(P<0.05),while there was no significant difference between PEN group and control group(P>0.05).There was no significant difference in the increase of ALB and HGB among the three groups(P>0.05).At week 14,the nutritional risk rate decreased from 90.9%(10/11)to 54.5%(6/11)in EEN group,from 57.1%(8/14)to 28.6%(4/14)in PEN group,and from 54.5%(6/11)to 45.5%(45.5)in control group.In terms of blood routine indexes and inflammatory biomarkers,the decline of CRP in EEN group was the most obvious at week 14,but there was no significant difference among the three groups.There was no significant difference in the decrease of WBC,NEU%and PLT among the three groups(P>0.05).From week 6 to week 14,the decrease of WBC and PLT in EEN group were the most obvious,PEN group and control group decreased successively.The difference in the decrease of PLT between EEN group and control group was statistically significant(P<0.05).At week 14,the increase of HGB of incipient patients were higher than that of relapsing patients(P<0.05),the increase of BMI of male patients were higher than that of female patients(P<0.05).There were no significant difference on the efficacy of EEN in age or location of disease(P>0.05).Conclusions:Exclusive enteral nutritional therapy by improved oral method could quickly and effectively improve the nutritional status,reduce inflammation,reduce disease activity and accelerate the induction of remission in patients with active Crohn’s disease.Age and location of disease had no significant effect on the efficacy of EEN.The increase in HGB was greater in incipient patients than in relapsing patients,the increase in BMI was greater in men than in women.PEN could improve the nutritional status of patients with CD,but the effect of inducing remission was not as good as that of EEN.