Polymeric enteral diets as primary treatment of active Crohn's disease: a prospective steroid controlled trial

• Published in: Gut Vol. 34; no. 6; pp. 778 - 782
• Main Authors: González-Huix, F, de León, R, Fernández-Bañares, F, Esteve, M, Cabré, E, Acero, D, Abad-Lacruz, A, Figa, M, Guilera, M, Planas, R
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Society of Gastroenterology 01-06-1993; BMJ; BMJ Publishing Group LTD; BMJ Group
• Subjects: Acute Disease; Adult; Alimentació enteral; Assaigs clínics; Biological and medical sciences; Clinical trials; Crohn Disease - drug therapy; Crohn Disease - therapy; Crohn's disease; Diet; Enteral feeding; Enteral Nutrition - methods; Esteroides; Female; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Malaltia de Crohn; Male; Medical sciences; Other diseases. Semiology; Prednisolone - therapeutic use; Prospective Studies; Remission Induction; Steroids; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Steroid; Human; Nutrition; Antiinflammatory agent; Adjuvant treatment; Prednisone; Enteral administration; Inflammatory disease; Crohn disease; Chemotherapy; Treatment; Diet; Digestive diseases; Intestinal disease; Remission
• ISSN: 0017-5749; 1468-3288; 1458-3288
• DOI: 10.1136/gut.34.6.778

Thirty two patients with active Crohn's disease were included in a controlled randomised trial to determine the efficacy and safety of polymeric enteral nutrition compared with steroids, to achieve and maintain clinical remission. The polymeric diet was administered through a fine bore nasogastric tube by continuous, pump assisted infusion (2800 (SEM 120) kcal/day). The steroid group received 1 mg/kg/day of prednisone. Both treatments were effective in inducing clinical remission: 15 of the 17 patients given steroids and 12 of the 15 patients assigned to the polymeric diet went into clinical remission (defined by a Van Hees index < 120) within four weeks of treatment. The percentage reduction of the Van Hees index was 34.8 (4.9)% for steroids and 32.3 (5)% for enteral nutrition (mean difference 2.5%; 95% CI--11.8% to +16.8%). Mean time elapsed to achieve remission was similar in both groups (2.0 (1) v 2.4 (1.2) weeks). Tolerance of the enteral diet was excellent. Four patients in the steroid group had mild complications attributable to this treatment. Ten patients (66.6%) in the steroid group and five (41.6%) in the enteral nutrition group relapsed within a year of discharge, but no differences were found in the cumulative probability of relapse during the follow up period. These results suggest that polymeric enteral nutrition is as safe and effective as steroids in inducing short term remission in active Crohn's disease.