Exclusive Enteral Nutrition in Adult Crohn’s Disease: an Overview of Clinical Practice and Perceived Barriers

Figures & data

Table 1 Main Studies That Have Explored the Use of Exclusive Enteral Nutrition in Adult Crohn’s Disease Patients

Authors, Year	Study Design	Study Population	Intervention/Groups	Outcomes	Key Findings
Gassull et al.,^Citation22 2002	Multicenter, Randomized, Double Blind Clinical Trial	62 active CD patients aged 18–65 years	Patients were enrolled into 3 groups to use for 4 weeks: (1) EEN high in oleate and low in linoleate (2) EEN high in linoleate and low in oleate (3) corticosteroids	Efficacy of two whole protein-based diets with different fat compositions for inducing clinical remission compared with steroids	Clinical remission in adult CD patients is achieved in about 2/3 of cases after 4 weeks of exclusive polymeric enteral diet high in linolate and low in oleate
Yamamoto et al.,^Citation28 2005	Prospective Study	28 active CD patients with a median age of 28 years	4 weeks of elemental diet	Impact of elemental diet on mucosal inflammation in young adult with CD	Endoscopic healing is obtained in about 40% of CD patients in association with a decline of the mucosal proinflammatory cytokines
Guo et al.,^Citation63 2013	Non-Randomized Clinical Trial	13 active CD patients aged 18–40 years	4 weeks of polymeric enteral nutrition	Impact of EEN on health-related quality of life in adults with active CD	4-week treatment of EEN significantly improves health-related quality of life
Yang et al.,^Citation58 2017	Prospective Study	41 complicated CD patients aged 18–60 years	12 weeks of EEN	Efficacy of EEN in adult CD patients complicated with intestinal fistula/abdominal abscess or inflammatory intestinal stricture	12 week-treatment is effective for inducing early clinical remission, mucosal healing, promoting fistula closure and reducing the abscess size
Wall et al.,^Citation20 2018	Prospective Study	30 active CD patients aged 16–40 years	Patients were recruited into 2 groups to use: 1) EEN for 8 weeks 2) EEN for 2 weeks + PEN for following 6 weeks	Impact of EN on clinical symptoms, nutrition and inflammatory markers	EN is an effective treatment in motivated adult CD patients that may prefer nutritional therapies to corticosteroids for inducing remission
Xu et al.,^Citation61 2019	Retrospective Study	91 active isolated colonic CD patients with a median age of 33 years	EEN for more than 2 weeks	Factors that influence the response to EEN in isolated colonic CD patients	Pancolitis is the greatest contributor to the risk of non-response to EEN, followed by lean BMI and colonic lesion features in isolated colonic CD patients
Wall et al.,^Citation67 2020	Prospective Study	38 active CD patients with a median age of 27 years	Patients were recruited into 2 groups to use: 1) EEN for 8 weeks 2) EEN for 2 weeks + PEN for following 6 weeks	Association between adherence to EEN and conscientious personality	Conscientiousness is associated with adherence to nutritional therapy and should be considered
Shukla et al.,^Citation21 2020	Prospective Study	27 active CD patients with a median age of 45 years	EEN for 6 weeks with a weekly specialist dietetic support	Clinical remission and adherence to EEN treatment	EEN may be achievable for adult CD patients for inducing remission when an additional professional dietetic support is provided
Yang et al.,^Citation59 2021	Retrospective Study	14 active CD pregnant women	12 weeks of EEN	Efficacy of EEN for inducing remission in women with a CD relapse during pregnancy	EEN may provide a safe and effective alternative treatment to induce remission in pregnant women
Sharma et al.,^Citation60 2021	Retrospective Study	31 complicated CD patients with a median age of 34 years	EEN for a median duration of 4 weeks	Efficacy of EEN for inducing remission in complicated CD patients	4 week-treatment of EEN significantly improves clinical symptoms and biochemical parameters of adult patients with complicated CD
Mutsekwa et al.,^Citation65 2021	Exploratory Qualitative Study	17 active CD patients with a median age of 45 years	Patients who had completed EEN treatment were interviewed	(1) Personal experience of EEN treatment (2) Potential strategies to manage challenges during EEN (3) Potential enablers for adherence to EEN	Support from social networks and health professionals, taste of polymeric formulas, and patients’ perceived self-efficacy were strong enablers for adherence

Gassull MA, Fernández-Bañares F, Cabré E, et al. Fat composition may be a clue to explain the primary therapeutic effect of enteral nutrition in Crohn’s disease: results of a double blind randomised multicentre European trial. Gut. 2002;51(2):164–168. doi:10.1136/gut.51.2.164

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Yamamoto T, Nakahigashi M, Umegae S, Kitagawa T, Matsumoto K. Impact of elemental diet on mucosal inflammation in patients with active Crohn’s disease: cytokine production and endoscopic and histological findings. Inflamm Bowel Dis. 2005;11(6):580–588. doi:10.1097/01.mib.0000161307.58327.96

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Guo Z, Wu R, Zhu W, et al. Effect of exclusive enteral nutrition on health-related quality of life for adults with active Crohn’s disease. Nutr Clin Pract. 2013;28(4):499–505. doi:10.1177/0884533613487218

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Yang Q, Gao X, Chen H, et al. Efficacy of exclusive enteral nutrition in complicated Crohn’s disease. Scand J Gastroenterol. 2017;52(9):995–1001. doi:10.1080/00365521.2017.1335770

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Wall CL, Gearry RB, Day AS. Treatment of Active Crohn’s Disease with Exclusive and Partial Enteral Nutrition: a Pilot Study in Adults. Inflamm Intest Dis. 2018;2(4):219–227. doi:10.1159/000489630.

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Xu Y, Guo Z, Huang L, et al. A nomogram for predicting the response to exclusive enteral nutrition in adult patients with isolated colonic Crohn’s disease. Therap Adv Gastroenterol. 2019;11(12):1756284819881301. doi:10.1177/1756284819881301

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Wall CL, McCombie A, Mulder R, Day AS, Gearry RB. Adherence to exclusive enteral nutrition by adults with active Crohn’s disease is associated with conscientiousness personality trait: a sub-study. J Hum Nutr Diet. 2020;33(6):752–757. doi:10.1111/jhn.12787.

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Shukla D, Purcell L, Palmer M, Pillay L. Exclusive enteral nutrition for the treatment of adult Crohn’s disease. J Crohns Colitis. 2020;14(1):S041–S041. doi:10.1093/ecco-jcc/jjz203.040

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Yang Q, Tang J, Ding N, et al. Twelve-week peptide-based formula therapy may be effective in inducing remission of active Crohn disease among women who are pregnant or preparing for pregnancy. Nutr Clin Pract. 2021. doi:10.1002/ncp.10733.

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Sharma S, Gupta A, Kedia S, et al. Efficacy and tolerability of exclusive enteral nutrition in adult patients with complicated Crohn’s disease. Intest Res. 2021;19(3):291–300. doi:10.5217/ir.2019.09172

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Mutsekwa RN, Edwards JT, Angus RL. Exclusive enteral nutrition in the management of Crohn’s disease: a qualitative exploration of experiences, challenges and enablers in adult patients. J Hum Nutr Diet. 2021;34(2):440–449. doi:10.1111/jhn.12829

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