Exclusive enteral feeding may help some Crohn's patients avoid surgery

Last Updated: 2017-02-01

By Anne Harding

NEW YORK (Reuters Health) - Exclusive enteral nutrition (EEN) may help avoid surgery in some Crohn's disease (CD) patients presenting with strictures or penetrating complications, new research shows.

"We know that about 60% to 70% of patients with Crohn's disease will require surgery at some point during the course of the disease," Dr. Neel Heerasing of the Royal Devon and Exeter NHS Foundation Trust in Exeter, U.K., told Reuters Health by phone.

"If someone's presenting with a complication, rather than jumping in and going straight to surgery, perhaps we could optimize them with exclusive enteral nutrition," he said.

Patients diagnosed with CD are often put on EEN for several weeks upon diagnosis, Dr. Heerasing and his colleagues note in their report, published online January 20 in Alimentary Pharmacology and Therapeutics. While EEN is used extensively in pediatric CD, they add, concerns about tolerability have limited its use in adults.

Dr. Heerasing and his colleagues hypothesized that EEN might offer a bridge to surgery in patients while reducing postoperative complications. Based on disease behavior, surgery type, age at diagnosis and disease duration, they matched records of 38 patients awaiting surgery for stricture or penetrating complications who had received EEN for at least two weeks to 76 control patients who went straight to surgery.

Thirteen patients in the enteral nutrition group were able to avoid surgery. This group also had a significantly shorter median length of surgery (3 vs. 3.5 hours). Patients who went straight to surgery had 9.1 times greater odds of developing postoperative abscess and/or anastomotic leak after the procedure.

Patients in the EEN group had a significant drop in C-reactive protein levels, as did patients who received antibiotics, with EEN and antibiotics having additive effects.

"You'll need more prospective studies to try and confirm this research and also explain how enteral nutrition can improve surgical outcomes," Dr. Heerasing said. EEN could reduce inflammation by modulating the gut microbiome, he added, and it may also improve mucosal healing.

At his own hospital, Dr. Heerasing noted, clinicians have been using EEN to optimize CD patients before surgery for years. To use EEN safely and effectively, he said, close collaboration among gastroenterologists, surgeons, dietitians and nursing staff is necessary.

"You need a good multidisciplinary team with an emphasis on holistic care for the patient," he said.

SOURCE: http://bit.ly/2krq1dt

Aliment Pharmacol Ther 2017.