Enteral Nutrition

Exclusive Enteral Nutrition is primarily used to induce remission, particularly for pediatric Crohn's Disease (CD), as it has been studied extensively in this population. However, a likely potential benefit in ulcerative colitis (UC) has been suggested, and further research is recommended to evaluate its use in UC (Shaoul R et al). Exclusive Enteral Nutrition is often considered for use only in pediatric patients; however, a recent paper has shown it to be effective for inducing remission in adult patients with CD complicated with fistulas, abscesses, and strictures (Yang Q et al), and when used in the perioperative setting to avoid the need for surgery in some patients (Heerasing N et al). Although larger trials are needed to validate the use of EEN in these settings, there is potential for improved outcomes in complicated patients (Adamji M and Day AS). A publication by an Australian and New Zealand IBD working group provides recommendations for the use of EEN in active adult CD for the following clinical indications: induction of remission, as a bridge to medical therapy, preoperatively, and in the management of abdominal abscess or fistula (Day A et al). A recent review by Palchaudhuri S et al outlines the potential benefits of EEN and other dietary considerations for hospitalized patients.

Partial Enteral Nutrition uses a combination of liquid nutrition and solid foods. It is generally used for maintenance of remission after completing Exclusive Enteral Nutrition. The proportion of solid food is gradually increased until an optimal ratio of food/liquid nutrition is achieved for maintaining remission. The ongoing use of PEN may prolong remission, delay the need for steroids, lead to growth and better nutrition, and be helpful in children experiencing pubertal delay (Critch J et al on Behalf of the NASPGHAN IBD Committee). Partial Enteral Nutrition using more than 900 kcal/day was recently noted to independently lower the rate of surgical recurrence (Shinozaki M et al).