Safety And Efficacy Of Enteral Nutrition For Undrainable Abdominal Abscesses In Crohn’s Disease

BackgroundThe undrainable abdominal abscesses in Crohn’s disease (CD) are not uncommon. The treatment protocol is still under debate. The current treatment are antibiotic therapy and surgical drainage with or without bowel resection. And the enteral nutrition (EN) therapy had been confirmed useful in the CD patients already. The current study was conducted to assess the safety and efficacy of EN for undrainable abscesses in CD.ObjectiveTo evaluate the safety of EN for abdomial abscesses in CD; the surgical rate of patients under EN; and the role of EN on the preoperative optimization and postoperative outcomes.MethodsA consecutive cohort of CD patients (n=46) with undrainable abdominal abscesses between Jan 2011 to June 2015 were retrospectively analyzed. They were divided into 2 groups:EN or Non-EN. The cumulative for surgery was described by Kaplan-Meier curves. Predictors of surgery were analyzed by multivariable Cox proportional hazards regression analysis. The changes in serum albumin, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) were compared at the time of abscess diagnosis and operation for patients receiving surgery.Results33 patients were in the EN group, and 13 patients were in the Non-EN group. The median follow-up time was 19.8 (3.0-63.3) months. During the follow-up period, no serious adverse events were reported in all patients with EN treatment. The cumulative surgical rate was significantly lower in the EN group than the Non-EN group(P=0.001). EN (HR,0.446; 95%CI,0.446-0.204; P=0.042), concomitant infliximab use after abscess resolution (HR,0.117; 95% CI,0.042-0.330; P=0.042) were significantly associated with a decreased risk of surgery. Previous abdominal surgery (HR,2.957; 95% CI,1.266-6.909; P=0.012), abscess diameter> 3cm (HR,8.618; 95% CI, 2.692-27.593; P<0.001) were significantly associated with an increased risk of operation. EN increased albumin level, while decreased ESR and CRP significantly for patients requiring surgery.ConclusionsEN can be safely used in CD patients presenting with undrainable abdominal abscesses. It is effective to improve nutrition status, cool down inflammation, and reduce surgical rate.