Nutrition in IBD
Discuss nutrition as primary therapy for active CD?
- EN (ONS and Tube feeding- TF) is effective in the treatment of the acute phase of the disease and is considered the first line therapy in children. The mechanism of beneficial effect of EN remains unclear.
- In adults, however, treatment with corticosteroids is more effective: therefore, in adults, EN as sole therapy for acute CD is indicated mainly when treatment with corticosteroids is not feasible, e.g. due to intolerance or refusal.
- The localisation of CD has no prognostic value for the response to EN. Approximately 60% of all patients reach remission.
- TPN is no better than EN in the therapy of active CD and should therefore be used only in patients with a contraindication to or intolerance of EN
- Compliance of patients receiving EN is low due to the unpalatability of the enteral formula or intolerance.
Discuss nutrition for maintenance of remission in CD?
- The length of remission and subsequent relapse rate after remission induced by EN are comparable to that after treatment with corticosteroids in children and adults.
- In longstanding (more than 1 year) clinical remission and in the absence of nutritional deficits, a benefit of EN has not been demonstrated.
- One-year relapse rates of active CD by EN are comparable to steroid therapy.
Discuss EN in CD?
- There are no significant differences in the effect of free amino acid, peptide-based and whole protein formulae for TF. Nutritional support with normal food is considered the treatment of choice.
- ONS can provide upto 600 Kcal/day in addition to normal food. If a higher intake is required, TF is necessary.
- TF can be safely delivered by a nasogastric tube (NGT) or percutaneous endoscopic gastrostomy (PEG).
- In some patients, who are intolerant to whole protein formulae AA or peptide-based formulae might however be tried.
Discuss nutrition in ulcerative colitis?
EN is not recommended as treatment of active UC.
Discuss parenteral nutrition in IBD?
- Although the faecal stream is likely to play a role in the pathogenesis of CD, there is no evidence that bowel rest combined with parenteral nutrition may be beneficial in refractory CD.
- There are no studies investigating the effect of drug treatment on nutritional status in UC. However, folic acid deficit may be related to sulphasalazine therapy.
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