Partial Enteral Nutrition For The Maintenance Of Remission In Adults With Inactive Crohn's Disease:A Meta-analysis

Background:Enteral nutrition for inducing remission of active CD is clear,and has been considered as the first-line therapy.However,the efficacy of enteral nutrition as maintenance of remission in patients with inactive CD has not been clarified yet.Objective:To systematically evaluate the evidence of the efficacy of partial enteral nutrition for maintaining remission in adults with inactive CD by a meta-analysis.Methods:We searched several electronic databases(PubMed,EMbase,Cochrane Library and Web of Science)from inception to to December 2016 for applicable studies to identify relevant studies for review and analysis.Studies published in English were considered in this review.After a final set of studies was identified,the list of references reported in the included studies was reviewed to identify additional studies.Screening of titles andabstracts,data extraction and quality assessment was undertaken independently.All the data were done using Review Manager 5.3 software and Stata 11.0 software.Results:A total of 1426 records were identified,10 of which met the inclusion criteria.7 of 10 presented data that could be used in quantitative analysis,and 3 could be used in qualitative analysis.The results of quantitative analysis showed that the RR of CD clinical relapse rates between PEN and non-EN maintenance therapy for 12-24 months was 0.57(95% CI,0.38~0.84,P=0.005);The RRs of CD clinical remission rates between EN and non-EN maintenance therapy for 6,12,24,and 60 months were 1.24(95% CI,1.01~1.52,P=0.04),1.56(95% CI,1.26~1.92,P<0.0001),2.29(95% CI,1.16~4.51,P=0.02),2.17(95% CI,1.03~4.55,P=0.04),respectively.The results of qualitative analysis showed that there was no significant difference in endoscopic recurrence rate between PEN and non-ENmaintenance therapy for 6 months(P> 0.05),but a significant difference for 12 months(P<0.05);There was no significant difference in the rate of CD remission between PEN and 6-MP maintenance therapy for 12 and 24 months,respectively(P> 0.05);In all three studies investigating impacts of the doses of PEN on clinical remission,higher doses of PEN were associated with higher remission rates:?30kcal/kg ideal body weight/day(vs.<30kcal/kg ideal body weight/day),?1200kcal/day(vs.<1200kcal/day),and>900kcal/day(vs.<900kcal/day).Conclusion :The available data suggest that PEN(elemental diet)is more effective than non-EN for the maintenance of remission in adults with inactive CD,and even to maintain long-term remission.As the current studies are still less,the efficacy and long-term effects of PEN as maintenance therapy for adult CD patients still require more,large sample,high quality randomized controlled trials to further confirm.