Exclusive enteral nutrition with oral polymeric diet helps in inducing clinical and biochemical remission in adults with active Crohn's disease

Abstract

Background and Aims: Exclusive enteral nutrition (EEN) is not routinely used as induction therapy for adults with active Crohn's disease (CD). The aim of this study was to assess the effectiveness of EEN with oral polymeric formula as an adjunct for inducing clinical and biochemical remission in adults with active CD. Methods: We performed a retrospective analysis of data from January 2018 to September 2019 on all patients with active CD who commenced EEN. The primary end point (PE) was clinical remission (Crohn's Disease Activity Index [CDAI] ≤150) or response (100-point decrease in CDAI) at 8 weeks. The secondary end point (SE) was biochemical remission (C-reactive protein level ≤5 mg/L or feces calprotectin level ≤150 mcg/g) at 8 weeks in those whose baseline values were elevated. We also aimed to identify predictors of response to EEN therapy. Results: Sixty-six patients commenced EEN; 53 (of 66; 80.3%) completed the prescribed EEN course. At 8 weeks, 42 (of 66; 63.6%) patients achieved the PE, and 30 (of 53; 56.6%) patients achieved the SE. Patients receiving EEN for ≥6 weeks achieved the PE (72% vs 47.8%; odds ratio [OR], 2.8; P = 0.047; CI, 0.97–8.16) and SE (67.6% vs 36.8%; OR, 3.58; P = 0.035; CI, 1.1–11.63) more frequently compared with patients who received EEN for <6 weeks. Nine patients reported adverse effects. Conclusion: Polymeric EEN is well tolerated, safe, and effective in inducing clinical and biochemical remission in adults with active CD. EEN duration of ≥6 weeks has better outcomes.