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KMID : 0988920210190030291
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Intestinal Research
2021 Volume.19 No. 3 p.291 ~ p.300
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Efficacy and tolerability of exclusive enteral nutrition in adult patients with complicated Crohn’s disease
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Sharma Sanchit
Gupta Arti
Kedia Saurabh
Agarwal Samagra
Singh Namrata
Goyal Sandeep
Jain Saransh
Gupta Vipin
Sahu Pabitra
Ahuja Vineet
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Abstract
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Background/Aims: Exclusive enteral nutrition (EEN), an established modality for pediatric Crohn’s disease (CD) is seldomly utilized in adults. The present study reports the outcome of EEN in adult CD patients at a tertiary care hospital in India.
Methods: This was a retrospective analysis of CD patients who received EEN as a sole modality/adjunct to other treatment. The primary and secondary outcomes changed in Crohn’s Disease Activity Index (CDAI), and clinical response (decline in CDAI > 70), respectively, at 4 and 8 weeks. Subgroup analysis evaluated response across different phenotypes, EEN formulations and prior treatment. Linear mixed effect model was created to assess the predictors of EEN response.
Results: Thirty-one CD patients received EEN over median duration of 4 weeks (range, 2?6 weeks). CDAI showed a significant improvement post EEN at 4 (baseline 290 [260?320] vs. 240 [180?280], P=0.001) and 8 weeks (baseline 290 [260?320] vs. 186 [160?240], P=0.001), respectively. The cumulative clinical response rates at 4 and 8 weeks were 37.3% and 80.4% respectively. The clinical response rates at 8 weeks across B1 (n = 4), B2 (n = 18) and B3 (n = 9) phenotypes were 50%, 78.8% and 100% respectively (log-rank test, P=0.093). The response rates at 8 weeks with polymeric (n = 8) and semi-elemental diet (n = 23) were 75% and 82.6%% respectively (log-rank test, P=0.49). Baseline CDAI (odds ratio, 1.008; 95% confidence interval, 1.002?1.017; P=0.046) predicted response to EEN.
Conclusions: EEN was effective in inducing clinical response across different phenotypes of CD. Baseline disease activity remained the most important predictor of clinical response to EEN.
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KEYWORD
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Exclusive enteral nutrition, Crohn disease, Crohn’s Disease Activity Index, Inflammation
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