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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
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Abstract
PDF
Supplementary Material
PubReader
ePub - 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
- Adjunct polymeric exclusive enteral nutrition helps achieve biochemical remission in active Crohn’s disease in adults irrespective of disease location and concomitant corticosteroid use
- 7,737 View
- 312 Download
- 18 Web of Science
- 18 Crossref
- Inflammatory bowel diseases
- Exclusive enteral nutrition for induction of remission in anti-tumor necrosis factor refractory adult Crohn’s disease: the Indian experience
- Ajit Sood, Arshdeep Singh, Ritu Sudhakar, Vandana Midha, Ramit Mahajan, Varun Mehta, Yogesh Kumar Gupta, Kirandeep Kaur
- Intest Res 2020;18(2):184-191. Published online February 25, 2020
- DOI: https://doi.org/10.5217/ir.2019.00094
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Abstract
PDFSupplementary MaterialPubReaderePub
- Background/Aims
Exclusive enteral nutrition (EEN) is recommended for induction of remission in pediatric Crohn’s disease (CD). However, it is not currently recommended for inducing remission in adults. This report describes the use of 12-week EEN for induction of remission in anti-tumor necrosis factor (anti-TNF) refractory adult CD.
Methods
This is a retrospective analysis of adults with moderate to severe active (Crohn’s Disease Activity Index [CDAI] >220) anti-TNF refractory CD, who received EEN for 12 weeks between April 2018 and March 2019 at Dayanand Medical College and Hospital, Ludhiana, India. Primary outcomes included achievement of clinical remission and fistula healing at 12 weeks. Improvement in inflammatory markers and nutritional status were the secondary end points.
Results
Out of 23 patients who received anti-TNF agents, 7 (30.4%) were refractory and were offered EEN as a salvage therapy. Six patients (66.7% females, mean age 25.6±6.5 years) consented. Four patients (66.6%) achieved clinical remission (CDAI <150). Mean CDAI of patients decreased significantly after 12 weeks of EEN (388.8±74.8 vs. 160.0±25.2, P<0.001). Perianal fistulas showed clinical response (drainage decreased by >50%), though none achieved remission. Entero-enteric fistulae showed complete healing. Mean body mass index improved from 15.6±3.1 to 18.9±1.9 kg/m2 at week 12 (P=0.003). Hemoglobin and serum albumin also improved from 8.2±1.1 g/dL and 2.8±0.3 g/dL at baseline to 12.6±0.6 g/dL and 3.6±0.5 g/dL post-EEN respectively (P<0.001 and P=0.006 respectively).
Conclusions
EEN appears to be an effective and well tolerated therapy for induction of remission in anti-TNF refractory adult CD. More data from prospective trials with larger number of patients is required. -
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 - 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 - Management of Perianal Fistulizing Crohn’s Disease
Arshdeep Singh, Vandana Midha, Gursimran Singh Kochhar, Bo Shen, Ajit Sood
Inflammatory Bowel Diseases.2024; 30(9): 1579. CrossRef - Pharmacogenetics in personalized treatment in pediatric patients with inflammatory bowel disease (IBD)
Daniela Kosorínová, Pavlína Suchá, Zuzana Havlíčeková, Marek Pršo, Pavol Dvoran, Peter Bánovčin
Česko-slovenská pediatrie.2024; 79(4): 213. CrossRef - Clinical and magnetic resonance imaging spectrum of complex perianal fistulizing Crohn’s disease: A cohort study from northern India
Arshdeep Singh, Chandan Kakkar, Shreya Garg, Kirti Arora, Vandana Midha, Ramit Mahajan, Satpal Singh Virk, Narender Pal Jain, Dharmatma Singh, Kriti Sood, Ashish Tripathi, Dhruv Gupta, Ishita Gupta Kaushal, Ritu Dhawan Galhotra, Kavita Saggar, Ajit Sood
Indian Journal of Gastroenterology.2023; 42(5): 668. 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 - Incidence and Prevalence of Inflammatory Bowel Disease across Asia
Jihye Park, Jae Hee Cheon
Yonsei Medical Journal.2021; 62(2): 99. 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 - Pharmacogenetics-based personalized treatment in patients with inflammatory bowel disease: A review
Ji Young Chang, Jae Hee Cheon
Precision and Future Medicine.2021; 5(4): 151. CrossRef - Enteral nutrition in the biologic era: learn from yesterday, live for today, hope for tomorrow
Tadakazu Hisamatsu
Intestinal Research.2020; 18(2): 139. CrossRef
- Adjunct polymeric exclusive enteral nutrition helps achieve biochemical remission in active Crohn’s disease in adults irrespective of disease location and concomitant corticosteroid use
- 7,913 View
- 187 Download
- 11 Web of Science
- 10 Crossref
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