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Lessons from an audit of exclusive enteral nutrition in adult inpatients and outpatients with active Crohn’s disease: a single-centre experience
  1. Sarah L Melton1,2,
  2. Jessica A Fitzpatrick1,2,
  3. Kirstin M Taylor1,2,
  4. Emma P Halmos1,2,
  5. Peter R Gibson1,2
  1. 1Gastroenterology, Monash University, Melbourne, Victoria, Australia
  2. 2Gastroenterology, Alfred Health, Melbourne, Victoria, Australia
  1. Correspondence to Sarah L Melton, Gastroenterology, Monash University, Melbourne, VIC 3800, Australia; sarah.melton{at}monash.edu

Abstract

Objective To evaluate clinical outcomes, patterns of use, tolerance and nutritional outcomes of exclusive enteral nutrition (EEN) in adults with Crohn’s disease and to compare initiation in the inpatient compared with ambulatory care setting.

Design/method Adults with Crohn’s disease who received EEN at a single centre over 2.5 years were identified and outcomes assessed via examination of patient records.

Results EEN was initiated in 60 patients (23 as an outpatient) who had objective evidence of active disease. Of 49 in whom the goal was induction of remission, 28 completed EEN and 24 achieved clinical remission/response. Twenty-one withdrew prematurely, due to intolerance in 15 and disease factors in 6. Of 11 with a planned intervention, 6 fulfilled the goal of downstaging disease while two were intolerant. Completion of the prescribed therapy was associated with self-reported adherence to EEN and with improvements in disease activity scores and biochemical markers. Malnutrition halved (40% to 20%) and intentional weight loss (median 5.1 kg) was achieved in six obese patients. The major reason for intolerance was the inability to accept total avoidance of non-formula food. There were no differences in any outcomes according to the location of initiation of therapy.

Conclusion Positive outcomes occur in 70% of adult patients with Crohn’s disease tolerating EEN and 81% in those who are able to completely adhere to EEN, without compromise of nutritional status. Similar success occurs when initiated as an inpatient or outpatient. Failure to tolerate EEN is the major hurdle to its use.

  • ENTERAL NUTRITION
  • CROHN'S DISEASE
  • INFLAMMATORY BOWEL DISEASE

Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information.

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Footnotes

  • Contributors SM: Planned the study, collated the data, undertook the statistical analysis, contributed to writing the paper, submitted the study and is the guarantor. JAF: Planned the study, conducted the study, contributed to writing the paper. EH: Assisted with statistical analysis, contributed to writing the paper. KMT: Planned the study, contributed to writing the paper. PRG: Assisted with oversight of the study/direction, assisted with statistical analysis and reporting of results, assisted with writing the paper. All authors wrote, revised and approved the final version of the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests EH: Consultant or advisory board member for Takeda, Dr Falk Pharma, Ferring and Janssen. Research support for investigator-driven studies from Atmo Biosciences and Mindset Health. PRG: Consultant or advisory board member for Anatara, Atmo Biosciences, Falk Pharma, Immunic Therapeutics, Novozymes, Novoviah, Comvita and Takeda. Research grants for investigator-driven studies from Atmo Biosciences and Mindset Health. Shareholder in Atmo Biosciences.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.