Enteral Nutritional Therapy For Induction Of Remission In Crohn's Disease:A Meta-analysis

Objective: To assess the efficacy and safety of enteral nutrition(EN) as the therapy to induce remission in Crohn's disease(CD).Methods: We searched databases including Pub Med, EMbase, the Cochrane Library,CBM, Wan Fang Data and CNKI for relevant randomized controlled trials(RCTs) of EN versus other treatments for CD patients(published up to January, 2016). Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the risk of bias of included studies. Meta-analysis was performed by Rev Man 5.3 software. We analysis the clinic remission rate,mucosal healing rate, relapse rate of 1 year follow up, incidence of adverse events and total rate of dropout compared with glucocorticoid(GC), parenteral nutrition(PN) and infliximab(IFX) for active CD patients.Result: Eighteen RCTs(including three abstracts) met the criteria were included in this meta-analysis. These RCTs included EN versus GC, PN, IFX for active CD patients.The results of meta-analysis showed that: EN was as effective as either GC[RR=0.84,95%CI(0.70 to 1.01),p=0.06] or PN[RR=0.91,95%CI(0.73 to 1.14),p=0.43] in active CD patients' clinic remission rate. However IFX was more effective than EN[RR=0.77,95%CI(0.62 to 0.96),p=0.02] for the induction of clinic remission. EN was more effective than GC in mucosal healing[RR=2.42,95%CI(1.53 to 3.84),p=0.0002] of pediatric active CD patients. There were also no difference among EN,GC and PN [RR= 0.70,95%CI(0.49 to 1.02),p=0.06] about relapse rate of 1 year follow up. There were also no difference among EN, GC, PN and IFX [RR= 1.31,95%CI(0.59 to 2.94),p=0.51] on incidence of adverse events. EN had an increased total rate of dropout than GC or PN [RR=3.44,95%CI( 2.02 to 5.86),p<0.00001].Conclusion: The analysis showed that EN was as effective as GC and PN for inducing clinic remission in active CD patients. However IFX was more effective than EN in clinic remission. EN induces high rates of mucosal healing when compared with GC in pediatric active CD. Serious advance events attributable to EN were not common in the included studies, but CD patients' compliance was poor.