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Original Articles
Inflammatory Bowel Diseases
Efficacy and tolerability of exclusive enteral nutrition in adult patients with complicated Crohn’s disease
Sanchit Sharma, Arti Gupta, Saurabh Kedia, Samagra Agarwal, Namrata Singh, Sandeep Goyal, Saransh Jain, Vipin Gupta, Pabitra Sahu, Sudheer Kumar Vuyyuru, Bhaskar Kante, Raju Sharma, Rajesh Panwar, Peush Sahni, Govind Makharia, Vineet Ahuja
Intest Res 2021;19(3):291-300.   Published online May 26, 2020
DOI: https://doi.org/10.5217/ir.2019.09172
AbstractAbstract PDFSupplementary MaterialPubReaderePub
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.

Citations

Citations to this article as recorded by  
  • Adjunct polymeric exclusive enteral nutrition helps achieve biochemical remission in active Crohn’s disease in adults irrespective of disease location and concomitant corticosteroid use
    Hellen Kuo, Katrina Tognolini, Rumbidzai Mutsekwa, Dheeraj Shukla, Laura Willmann, Hadi Moattar, Alexander Dorrington, Naveed Ishaq, Maneesha Bhullar, John Edwards, Waled Mohsen, Pradeep Kakkadasam Ramaswamy
    Frontline Gastroenterology.2025; 16(1): 3.     CrossRef
  • Inflammatory bowel disease in south Asia: a scoping review
    Shabari Shenoy, Anuraag Jena, Carrie Levinson, Vishal Sharma, Parakkal Deepak, Tina Aswani-Omprakash, Shaji Sebastian, Jean-Frederic Colombel, Manasi Agrawal
    The Lancet Gastroenterology & Hepatology.2025; 10(3): 259.     CrossRef
  • Enteral Nutrition in Crohn’s Disease: A Comprehensive Review of Its Role in Induction and Maintenance of Remission and Perioperative Management in Adult Patients
    André Bargas, Carolina Palmela, Luisa Glória
    Nutrients.2025; 17(9): 1481.     CrossRef
  • Pancreatic Enzyme Replacement Therapy Improves Exclusive Enteral Nutrition Related Diarrhea in Crohn's Disease: A Prospective Randomized Trial
    Jian Kang, Jing Wang, Juan Su, Wei Wang, Yueyue Lu, Zhishun Tang, Liping Zou, Anning Yin, Jiao Li, Haixia Ren, Qian Zhou, Huipeng Wan, Ping An
    United European Gastroenterology Journal.2025;[Epub]     CrossRef
  • Progress and Clinical Applications of Crohn’s Disease Exclusion Diet in Crohn’s Disease
    Duo Xu, Ziheng Peng, Yong Li, Qian Hou, Yu Peng, Xiaowei Liu
    Gut and Liver.2024; 18(3): 404.     CrossRef
  • Aktualisierte S3-Leitlinie „Diagnostik und Therapie des Morbus Crohn“ der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) (Version 4.1) – living guideline
    Andreas Sturm, Raja Atreya, Dominik Bettenworth, Bernd Bokemeyer, Axel Dignass, Robert Ehehalt, Christoph-Thomas Germer, P. C. Grunert, Ulf Helwig, Karoline Horisberger, Klaus Herrlinger, Peter Kienle, Torsten Kucharzik, Jost Langhorst, Christian Maaser,
    Zeitschrift für Gastroenterologie.2024; 62(08): 1229.     CrossRef
  • Refractory Crohn’s Disease: Perspectives, Unmet Needs and Innovations
    Luisa Bertin, Martina Crepaldi, Miriana Zanconato, Greta Lorenzon, Daria Maniero, Caterina De Barba, Erica Bonazzi, Sonia Facchin, Marco Scarpa, Cesare Ruffolo, Imerio Angriman, Andrea Buda, Fabiana Zingone, Edoardo Vincenzo Savarino, Brigida Barberio
    Clinical and Experimental Gastroenterology.2024; Volume 17: 261.     CrossRef
  • Use of oral diet and nutrition support in management of stricturing and fistulizing Crohn's disease
    Kush Fansiwala, Neha D. Shah, Kelly A. McNulty, Mary R. Kwaan, Berkeley N. Limketkai
    Nutrition in Clinical Practice.2023; 38(6): 1282.     CrossRef
  • Exclusive Enteral Nutrition Orchestrates Immunological Balances as Early as Week 4 in Adult Patients of Crohn’s Disease: A Pilot, Open-Lable Study
    Na Diao, Xinyu Liu, Minzhi Lin, Qingfan Yang, Bingyang Li, Jian Tang, Ni Ding, Xiang Gao, Kang Chao
    Nutrients.2023; 15(24): 5091.     CrossRef
  • Exclusive enteral nutrition with oral polymeric diet helps in inducing clinical and biochemical remission in adults with active Crohn's disease
    Pradeep Kakkadasam Ramaswamy
    Journal of Parenteral and Enteral Nutrition.2022; 46(2): 423.     CrossRef
  • Is the frequency of dietitian support associated with greater clinical improvements in adults with Crohn's disease undertaking exclusive enteral nutrition?
    Liz Purcell, Rumbidzai Mutsekwa, Rebecca Angus, Dheeraj Shukla, Michelle Palmer
    Journal of Human Nutrition and Dietetics.2022; 35(3): 435.     CrossRef
  • Aktualisierte S3-Leitlinie „Diagnostik und Therapie des Morbus Crohn“ der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) – August 2021 – AWMF-Registernummer: 021-004
    Andreas Sturm, Raja Atreya, Dominik Bettenworth, Bernd Bokemeyer, Axel Dignaß, Robert Ehehalt, Christoph Germer, Philip C. Grunert, Ulf Helwig, Klaus Herrlinger, Peter Kienle, Martin E. Kreis, Torsten Kucharzik, Jost Langhorst, Christian Maaser, Johann Oc
    Zeitschrift für Gastroenterologie.2022; 60(03): 332.     CrossRef
  • Diet and nutrition in the management of inflammatory bowel disease
    Pabitra Sahu, Saurabh Kedia, Vineet Ahuja, Rakesh K. Tandon
    Indian Journal of Gastroenterology.2021; 40(3): 253.     CrossRef
  • Review of exclusive enteral therapy in adult Crohn’s disease
    Nikola Mitrev, Hin Huang, Barbara Hannah, Viraj Chandana Kariyawasam
    BMJ Open Gastroenterology.2021; 8(1): e000745.     CrossRef
  • Current Use of EEN in Pre-Operative Optimisation in Crohn’s Disease
    Sharafaath Shariff, Gordon Moran, Caris Grimes, Rachel Margaret Cooney
    Nutrients.2021; 13(12): 4389.     CrossRef
  • Exclusive Enteral Nutrition in Adult Crohn’s Disease: an Overview of Clinical Practice and Perceived Barriers
    Roberto de Sire, Olga Maria Nardone, Anna Testa, Giulio Calabrese, Anna Caiazzo, Fabiana Castiglione
    Clinical and Experimental Gastroenterology.2021; Volume 14: 493.     CrossRef
  • Making Decisions about Dietary Therapy in Inflammatory Bowel Disease
    Sydney Solomon, Eunie Park, Joseph A. Picoraro
    Gastrointestinal Disorders.2020; 2(4): 353.     CrossRef
  • EEN Yesterday and Today … CDED Today and Tomorrow
    Marta Herrador-López, Rafael Martín-Masot, Víctor Manuel Navas-López
    Nutrients.2020; 12(12): 3793.     CrossRef
  • 7,737 View
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Miscellaneous
Patients with celiac disease are at high risk of developing metabolic syndrome and fatty liver
Ashish Agarwal, Alka Singh, Wajiha Mehtab, Vipin Gupta, Ashish Chauhan, Mahendra Singh Rajput, Namrata Singh, Vineet Ahuja, Govind K. Makharia
Intest Res 2021;19(1):106-114.   Published online April 22, 2020
DOI: https://doi.org/10.5217/ir.2019.00136
AbstractAbstract PDFPubReaderePub
Background/Aims
Gluten-free diet has an excess of fats and simple sugars and puts patients with celiac disease at risk of metabolic complications including metabolic syndrome and fatty liver. We assessed prevalence of metabolic syndrome and fatty liver in two cohorts of celiac disease.
Methods
Study was done in 2 groups. In group 1, 54 treatment naïve patients with celiac disease were recruited. Of them, 44 returned after 1-year of gluten-free diet and were reassessed. In group 2, 130 celiac disease patients on gluten-free diet for ≥1 year were recruited. All patients were assessed for anthropometric and metabolic parameters and fatty liver. Metabolic syndrome was defined as per consensus definition for Asian Indians. Fatty liver was defined as controlled attenuation parameter value >263 decibels by FibroScan.
Results
In group 1, of 44 treatment naïve patients with celiac disease, metabolic syndrome was present in 5 patients (11.4%) at baseline and 9 (18.2%) after 1 year of gluten-free diet. Patients having fatty liver increased from 6 patients (14.3%) at baseline to 13 (29.5%) after 1year of gluten-free diet (P=0.002). In group 2, of 130 patients with celiac disease on gluten-free diet for a median duration of 4 years, 30 out of 114 (26.3%) and 30 out of 130 patients (23%) had metabolic syndrome and fatty liver, respectively.
Conclusions
Patients with celiac disease are at high risk of developing metabolic syndrome and fatty liver, which increases further with gluten-free diet. These patients should be assessed for nutritional and metabolic features and counseled about balanced diet and physical activity regularly.

Citations

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    Sunaina Addanki, Anastasia Mashukova, Arkene Levy
    Intestinal Research.2025; 23(2): 193.     CrossRef
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    Noam Peleg, Yaron Niv, Ram Dickman, Doron Boltin, Alex Krauthammer, Michal Herman-Edelstein, Nidal Issa, Jacob E. Ollech, Tom Konikoff, Rachel Gingold-Belfer
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