Enteral Nutrition to Suppress Postoperative Crohn's Disease Recurrence: a Five-year Prospective Cohort Study

Overview

Journal Int J Colorectal Dis

Specialties Gastroenterology
General Surgery

Date 2012 Sep 28

PMID 23014978

Citations 36

Authors

Takayuki Yamamoto

Manabu Shiraki

Maki Nakahigashi

Satoru Umegae

Koichi Matsumoto

Affiliations

Soon will be listed here.

Abstract

Purpose: The aim of this study was to investigate the long-term effect of enteral nutrition (EN) as a maintenance therapy in Crohn's disease (CD) patients following surgery.

Methods: This study was an extension of our previous study to prolong the duration of intervention and follow-up from 1 to 5 years. Forty consecutive patients who underwent resection for ileal or ileocolic CD were included. Following surgery, 20 patients received continuous elemental diet infusion during the nighttime plus a low-fat diet during the daytime (EN group). Another 20 patients received neither nutritional therapy nor food restriction (control group). All patients were followed for 5 years after operation. No patient received corticosteroid, immunosuppressants, or infliximab except patients who developed recurrence. The end point of this study was recurrence requiring biologic therapy or reoperation. Recurrence rates were analyzed on an intention-to-treat basis.

Results: In the EN group, four patients could not continue tube intubation for elemental diet intake. Two patients (10 %) in the EN group and nine patients (45 %) in the control group developed recurrence requiring infliximab therapy (P = 0.03). The cumulative recurrence incidence rate requiring infliximab was significantly lower in the EN group vs the control group (P = 0.02). One patient (5 %) in the EN group and five patients (25 %) in the control group required reoperation for recurrence (P = 0.18). The cumulative incidence of reoperation was lower in the EN group vs the control group, the difference not being significant (P = 0.08).

Conclusion: The outcomes of this study suggest that EN therapy reduces the incidence of postoperative CD recurrence.

Citing Articles

Laparoscopic intracorporeal anastomosis open anastomosis for ileostomy reversal in Crohn's disease: A single center retrospective study.

Liu W, Xiong M, Chen G, Long Z, Xu C, Zhu L World J Gastrointest Surg. 2025; 17(1):98269.

PMID: 39872758 PMC: 11757179. DOI: 10.4240/wjgs.v17.i1.98269.

Managing Crohn's Disease Postoperative Recurrence Beyond Prophylaxis: A Comprehensive Review with Meta-Analysis.

Olteanu A, Klimko A, tieranu E, Bota A, Preda C, Tieranu I Biomedicines. 2024; 12(11).

PMID: 39595001 PMC: 11591769. DOI: 10.3390/biomedicines12112434.

Mechanisms of Action of Exclusive Enteral Nutrition and Other Nutritional Therapies in Crohn's Disease.

Geesala R, Gongloor P, Recharla N, Shi X Nutrients. 2024; 16(21).

PMID: 39519414 PMC: 11547457. DOI: 10.3390/nu16213581.

Role of Diet-Microbiome Interaction in Gastrointestinal Disorders and Strategies to Modulate Them with Microbiome-Targeted Therapies.

Jadhav A, Bajaj A, Xiao Y, Markandey M, Ahuja V, Kashyap P Annu Rev Nutr. 2023; 43:355-383.

PMID: 37380178 PMC: 10577587. DOI: 10.1146/annurev-nutr-061121-094908.

The Role of Partial Enteral Nutrition for Induction of Remission in Crohn's Disease: A Systematic Review of Controlled Trials.

Gonzalez-Torres L, Moreno-Alvarez A, Fernandez-Lorenzo A, Leis R, Solar-Boga A Nutrients. 2022; 14(24).

PMID: 36558422 PMC: 9784970. DOI: 10.3390/nu14245263.

References

Heuschkel R, Menache C, Megerian J, Baird A . Enteral nutrition and corticosteroids in the treatment of acute Crohn's disease in children. J Pediatr Gastroenterol Nutr. 2000; 31(1):8-15. DOI: 10.1097/00005176-200007000-00005. View

Yamamoto T, Nakahigashi M, Saniabadi A . Review article: diet and inflammatory bowel disease--epidemiology and treatment. Aliment Pharmacol Ther. 2009; 30(2):99-112. DOI: 10.1111/j.1365-2036.2009.04035.x. View

Takagi S, Utsunomiya K, Kuriyama S, Yokoyama H, Iwabuchi M, Takahashi H . Effectiveness of an 'half elemental diet' as maintenance therapy for Crohn's disease: A randomized-controlled trial. Aliment Pharmacol Ther. 2006; 24(9):1333-40. DOI: 10.1111/j.1365-2036.2006.03120.x. View

Lochs H, Dejong C, Hammarqvist F, Hebuterne X, Leon-Sanz M, Schutz T . ESPEN Guidelines on Enteral Nutrition: Gastroenterology. Clin Nutr. 2006; 25(2):260-74. DOI: 10.1016/j.clnu.2006.01.007. View

OMorain C, Segal A, Levi A . Elemental diet as primary treatment of acute Crohn's disease: a controlled trial. Br Med J (Clin Res Ed). 1984; 288(6434):1859-62. PMC: 1441790. DOI: 10.1136/bmj.288.6434.1859. View

Matsui T, Sakurai T, Yao T . Nutritional therapy for Crohn's disease in Japan. J Gastroenterol. 2005; 40 Suppl 16:25-31. DOI: 10.1007/BF02990575. View

Yamamoto T, Nakahigashi M, Umegae S, Kitagawa T, Matsumoto K . Impact of long-term enteral nutrition on clinical and endoscopic recurrence after resection for Crohn's disease: A prospective, non-randomized, parallel, controlled study. Aliment Pharmacol Ther. 2007; 25(1):67-72. DOI: 10.1111/j.1365-2036.2006.03158.x. View

Griffiths A, Ohlsson A, Sherman P, Sutherland L . Meta-analysis of enteral nutrition as a primary treatment of active Crohn's disease. Gastroenterology. 1995; 108(4):1056-67. DOI: 10.1016/0016-5085(95)90203-1. View

Hiwatashi N . Enteral nutrition for Crohn's disease in Japan. Dis Colon Rectum. 1997; 40(10 Suppl):S48-53. DOI: 10.1007/BF02062020. View

10.

Tsujikawa T, Andoh A, Fujiyama Y . Enteral and parenteral nutrition therapy for Crohn's disease. Curr Pharm Des. 2003; 9(4):323-32. DOI: 10.2174/1381612033391964. View

11.

Esaki M, Matsumoto T, Hizawa K, Nakamura S, Jo Y, Mibu R . Preventive effect of nutritional therapy against postoperative recurrence of Crohn disease, with reference to findings determined by intra-operative enteroscopy. Scand J Gastroenterol. 2005; 40(12):1431-7. DOI: 10.1080/00365520510023729. View

12.

Hodges P, Gee M, Grace M, SHERBANIUK R, WENSEL R, Thomson A . Protein-energy intake and malnutrition in Crohn's disease. J Am Diet Assoc. 1984; 84(12):1460-4. View

13.

Griffiths A . Enteral nutrition in the management of Crohn's disease. JPEN J Parenter Enteral Nutr. 2005; 29(4 Suppl):S108-12. DOI: 10.1177/01486071050290S4S108. View

14.

Doherty G, Bennett G, Patil S, Cheifetz A, Moss A . Interventions for prevention of post-operative recurrence of Crohn's disease. Cochrane Database Syst Rev. 2009; (4):CD006873. DOI: 10.1002/14651858.CD006873.pub2. View

15.

Yamamoto T, Nakahigashi M, Saniabadi A, Iwata T, Maruyama Y, Umegae S . Impacts of long-term enteral nutrition on clinical and endoscopic disease activities and mucosal cytokines during remission in patients with Crohn's disease: a prospective study. Inflamm Bowel Dis. 2007; 13(12):1493-501. DOI: 10.1002/ibd.20238. View

16.

Best W, Becktel J, SINGLETON J, KERN Jr F . Development of a Crohn's disease activity index. National Cooperative Crohn's Disease Study. Gastroenterology. 1976; 70(3):439-44. View

17.

Yamamoto T . Factors affecting recurrence after surgery for Crohn's disease. World J Gastroenterol. 2005; 11(26):3971-9. PMC: 4502089. DOI: 10.3748/wjg.v11.i26.3971. View

18.

Zurita V, Rawls D, Dyck W . Nutritional support in inflammatory bowel disease. Dig Dis. 1995; 13(2):92-107. DOI: 10.1159/000171491. View

19.

Verma S, Kirkwood B, Brown S, Giaffer M . Oral nutritional supplementation is effective in the maintenance of remission in Crohn's disease. Dig Liver Dis. 2001; 32(9):769-74. DOI: 10.1016/s1590-8658(00)80353-9. View

20.

Yamamoto T, Nakahigashi M, Umegae S, Matsumoto K . Prospective clinical trial: enteral nutrition during maintenance infliximab in Crohn's disease. J Gastroenterol. 2009; 45(1):24-9. DOI: 10.1007/s00535-009-0136-5. View