CONDITIONS & DISORDERS
CROHN’S DISEASE AND ENTERAL NUTRITION This article reports on the use of enteral nutrition (EN) for remission and looks at new research into partial enteral nutrition (PEN) and the Crohn’s Disease Exclusion Diet (CDED). Crohn’s disease is a form of inflammatory bowel disease (IBD), alongside ulcerative colitis. Both are long-term conditions that cause inflammation of the gut. It is unclear what causes IBD, but it is thought to be a combination of genetics and individual immune systems. Crohn’s disease can result in inflammation anywhere in the digestive tract, from the mouth to the anus, but is most commonly seen in the in small intestine or colon.1 Smoking is linked to an increased risk of developing Crohn’s disease.2 Symptoms can be unpleasant and include abdominal pain, loose and frequent bowel movements, fatigue and weight loss as a result of malabsorption. ENTERAL NUTRITION (EN)
Crohn’s disease is increasing in incidence worldwide.3 Dietary intervention is deemed important, as many of the drugs used in treating the condition involve immune suppression and carry associated risks of infections, or, in some cases, malignancy.4 Nevertheless, overall, there is a lack of evidence looking into diets specific to Crohn’s disease, particularly in adults. The use of EN – a liquid-only diet – for the management of Crohn’s disease was first described in the 1970s5 and it is known today, that EN given either orally or via a nasogastric (NG) tube may be used during a flare up. Exclusive EN has been seen to improve the symptoms of Crohn’s disease as it gives the bowel ‘rest’ and allows for mucosal healing. It has also been shown to reduce
Rebecca Gasche Specialist Dietitian, Countess of Chester Hospital NHS Trust
the production of bacterial metabolites within two weeks and reduce the bacterial coating with immunoglobulin.6 EN is usually taken for six to eight weeks and elemental or polymeric oral nutritional supplements or feeds can be used. DIETARY MANAGEMENT
For patients who experience stricturing Crohn’s (narrowing of the bowel), the ESPEN guidelines recommend that a diet with modified texture or EN may be advised.7 The guidelines go on to say that for patients with radiologically identified but asymptomatic stenosis of the intestine, it is common to recommend a diet low in fibre. However, there is no robust data to support this apparently logical approach. When symptoms are present, it may be necessary to adapt the diet to one of soft consistency, perhaps predominantly of nutritious fluids. There is also some evidence for the use of a low residue (low-fibre) diet if there are strictures as a result of Crohn’s disease.7 A literature review by Rhodes and Richman8 reported that indirect evidence for diet and IBD suggests that Crohn’s patients should have a diet that is low in animal fat, avoid foods that are high in insoluble fibre and avoid processed fatty foods. Supplementary vitamin D should be considered and dairy products if tolerated can be consumed to help ensure adequate calcium intakes. There is weak evidence that olive oil might be protective and evidence to suggest that strict
Rebecca has a keen interest and specialises in gastroenterology dietetics. She currently works in the community setting in the Chester area, running clinics and group sessions to manage a wide range of gastroenterology conditions.
REFERENCES Please visit: https://www. nhdmag.com/ references.html
www.NHDmag.com November 2019 - Issue 149
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