The Progress Of Enteral Nutrition In Adults With Inflammatory Bowel Disease

Objective: To provide a comprehensive up-to-date review of the roles of enteral nutrition(EN) for the induction and maintenance of remission in adults with inflammatory bowel disease(IBD), and the mechanism how EN works.Background: IBD are chronic, life-long, and relapsing diseases of the gastrointestinal tract. Currently, there exists no complete cure therapy for IBD. Malnutrition and specific nutritional deficiencies are frequent among IBD patients, particularly in patients with Crohn’s disease, thus, nutritional support is needed in the majorioty of IBD patients. EN is effective not only in induction of active CD, but also in maintenance of remission. Besides improving the state of nutrition, EN also contributes to modify the intestinal immune system, relieve inflammatory activity and symptoms, and finally improve the living quality of IBD patients. In some western countries, EN is generally seen as primary therapy in children CD population. In Japan, EN is still the routine treatment in adult with CD. However, according to the guidelines of other countries, EN is just recommended in the case that the patients decline drug therapy or as an adjunctive therapy, rather than first line therapy. In a word, this review will demonstrate the progress of EN treatment in adult IBD patients.Methods: Search for relevant studies and reviews on the achievements of EN for the induction and maintenance of remission in patients with IBD, and for the mechanism as well.Results: EN can improve the state of nutrition and the quality of life by modifying the intestinal microbiota, maintaining the barrier function of intestinal mucosa and direct anti-inflammatory effects, which is even as effective as corticosteroids, biological agents, immunosuppressors and aminosalicylic acid. The therapeutic effect could be better if EN combines with these traditional drugs or surgery. As for inductin of remission in adults with IBD, EN is less effective than traditional therapy, but for maintenance of remission, EN was pretty effective either by using alone or by combining with other therapies. There were some studies on the efficacy of EN in adults with Ulcerative colitis(UC), but large sample and multicentre studies are needed to support it.Conclusion: Although a great number of researches showed that EN can improve the state of nutrition, the condition and the living quality of IBD patients, further studies are still required to clarify the mechanism and clinical value of EN in adults with IBD.