Effects Of Exclusive Enteral Nutrition Therapy In Patients With Active Crohn's Disease

Background:The incidence of malnutrition in patients with inflammatory bowel disease(IBD)is high,especially in patients with Crohn's disease(CD).The role of exclusive enteral nutrition(EEN)therapy in children's CD has now been recognized,and many countries have adopted enteral nutrition as the first-line treatment for child patients.However,the application of EEN in adult CD patients is still controversial.Aim:To investigate the role of exclusive enteral nutrition(EEN)therapy in patients with active Crohn's disease(CD)and to evaluate changes in nutrition indicators,inflammation indicators and disease activity indicators after EEN treatment;and to analyze the effect of EEN treatment courses,whether or not to use drugs in combination and disease sites on the efficacy of EEN treatment.Methods:Recall the active CD patients who met the inclusion criteria during the period from September 2013 to March 2018 and had undergone exclusive enteral nutrition therapy in the Second Affiliated Hospital of Soochow University,and recorded changes of the Crohn's Disease Activity Index(CDAI)scores,Body mass index(BMI),C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),platelet count(PLT),hemoglobin(HB),and albumin(ALB)before and after EEN treatment.Then,the data were grouped by EEN treatment course,combination of drug therapy,disease sites.Statistical analyses were respectively performed on the data within and between groups by Wilcoxon rank sum test and Mann-Whitney U test.Result:This study included a total of 37 patients with active CD who met the inclusion criteria,including 12 patients with EEN alone and 25 patients with other drug treatment;17 patients and 16 patients treated with EEN for 8 weeks and 12 weeks,respectively.There were 4 cases with EEN treatment for more than 12w;9 cases with simple small intestine involvement group and 28 cases with small intestine and colon involvement group.After more than 8 weeks of EEN treatment,35 patients achieved clinical remission,and the reduction of CDAI score was more than 100 points in the remaining two patients.After EEN treatment,the levels of BMI,HB,ALB,ESR,CRP,and PLT were significantly improved compared with before(p <0.05).This study also found that: Regardless of whether the CD patients have combined drug treatment and whether the disease site is the same,the evaluation indexes in each subgroup after EEN treatment are significantly improved(p<0.05),however,the difference of indicators after treatment between groups was not statistically significant(p>0.05).Reduction of CDAI scores in patients treated with EEN for 8w was significantly lower than those treated with EEN for 12w(p<0.05),but there was no significant statistical difference in the decrease ranges of CDAI scores between the two groups(p>0.05),there was also no statistically significant difference on the levels of the other assessment indicators after EEN treatment between subgroups(p>0.05).Conclusion:This study shows that EEN treatment can effectively improve the patient's nutritional status and reduce the risk of malnutrition and disease activity.Whether the disease site is the same and whether it is combined with drug therapy,there were no significant effect on the efficacy of EEN,the EEN treatment course was not as long as possible.How to use appropriate and effective EEN treatment in different types of active CD patients still requires further research and exploration.