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Inflammatory bowel disease and nutritional support therapy

Published on Aug. 25, 2022Total Views: 1964 timesTotal Downloads: 829 timesDownloadMobile

Author: Zhi-Han XU Ying-Jie ZHAO Yu-Fang WANG

Affiliation: Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, China

Keywords: Inflammatory bowel disease Nutritional support therapy Enteral nutrition

DOI: 10.12173/j.issn.1004-5511.202204036

Reference: Xu ZH, Zhao YJ, Wang YF. Inflammatory bowel disease and nutritional support therapy[J]. Yixue Xinzhi Zazhi, 2022, 32(4): 303-309. DOI: 10.12173/j.issn.1004-5511.202204036.[Article in Chinese]

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Abstract

Malnutrition is a common problem among patients with inflammatory bowel disease especially in Crohn's disease. Each patient should be screened for nutritional risk, and where this is present, patients should undergo further nutritional assessment to identify those who need nutritional support therapy. This includes both enteral and parenteral nutrition. Enteral nutrition is the first choice for patients with sufficient intestinal function and tolerance. Enteral nutrition therapy can not only improve patients nutritional status, but also induces and maintains remission in Crohn's disease. There is a consensus on the use of enteral nutrition as the first-line treatment for the induction and maintenance of therapy for children with Crohn's disease. For adult patients , especially those whose disease is complicated by intestinal obstruction, intestinal fistula and perioperative patients, enteral nutrition also has an important adjuvant therapeutic effect. Parenteral nutrition should be considered only in cases where enteral nutrition cannot be implemented, if the nutritional requirements are high or if the nutritional status is expected to be improved in the short term. In this paper, the current literature is reviewed, the mechanisms and specific implementation methods of nutritional support therapy in inflammatory bowel disease are described, and the indications, contraindications, specific programs and complications of enteral nutrition and parenteral nutrition are summarized, in order to standardize the individualized nutrition plan for IBD patients, promote the improvement of patients' condition and provide a reference.

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References

1.Zhang YZ, Li YY. Inflammatory bowel disease: pathogenesis[J]. World J Gastroenterol, 2014, 20(1): 91-99. DOI: 10.3748/wjg.v20.i1.91.

2.Owczarek D, Rodacki T, Domagała-Rodacka R, et al. Diet and nutritional factors in inflammatory bowel diseases[J]. World J Gastroenterol, 2016, 22(3): 895-905. DOI: 10.37 48/wjg.v22.i3.895.

3.Roda G, Chien Ng S, Kotze PG, et al. Crohn's disease[J]. Nat Rev Dis Primers, 2020, 6(1): 22. DOI: 10.1038/s41572-020-0156-2.

4.Kiela PR, Ghishan FK. Physiology of intestinal absorption and secretion[J]. Best Pract Res Clin Gastroenterol, 2016, 30(2): 145-159. DOI: 10.1016/j.bpg.2016.02.007.

5.Balestrieri P, Ribolsi M, Guarino MPL, et al. Nutritional aspects in inflammatory bowel diseases[J]. Nutrients, 2020, 12(2): 372. DOI: 10.3390/nu12020372.

6.Ünal NG, Oruç N, Tomey O, et al. Malnutrition and sarcopenia are prevalent among inflammatory bowel disease patients with clinical remission[J]. Eur J Gastroenterol Hepatol, 2021, 33(11): 1367-1375. DOI: 10.1097/MEG.0000000000002044.

7.Prince A, Whelan K, Moosa A, et al. Nutritional problems in inflammatory bowel disease: the patient perspective[J]. J Crohns Colitis, 2011, 5(5): 443-450. DOI: 10.1016/j.crohns.2011.04.016.

8.Skouras T, Dodd S, Prasad Y, et al. Brief report: length of ileal resection correlates with severity of bile acid malabsorption in Crohn's disease[J]. Int J Colorectal Dis, 2019, 34(1): 185-188. DOI: 10.1007/s00384-018-3144-1.

9.Mahadea D, Adamczewska E, Ratajczak AE, et al. Iron deficiency anemia in inflammatory bowel diseases-a narrative review[J]. Nutrients, 2021, 13(11): 4008. DOI: 10.3390/nu13114008.

10.Ohyama W, Yamaoka M, Yokoi K, et al. Maternal Crohn's disease-related vitamin B12 deficient megaloblastic anemia in an infant[J]. Rinsho Ketsueki, 2016, 57(1): 15-19. DOI: 10.11406/rinketsu.57.15.

11.Steell L, Gray SR, Russell RK, et al. Pathogenesis of musculoskeletal deficits in children and adults with inflammatory bowel disease[J]. Nutrients, 2021, 13(8): 2899. DOI: 10.3390/nu13082899.

12.Bischoff SC, Escher J, Hébuterne X, et al. ESPEN guideline: clinical nutrition in inflammatory bowel disease[J]. Nutr Hosp, 2022, 39(3): 678-703. DOI: 10.20960/nh.03857.

13.Einav L, Hirsch A, Ron Y, et al. Risk factors for malnutrition among IBD patients[J]. Nutrients, 2021, 13(11): 4098. DOI: 10.3390/nu13114098.

14.Kondrup J, Rasmussen HH, Hamberg O, et al. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials[J]. Clin Nutr, 2003, 22(3): 321-336. DOI: 10.1016/s0261-5614(02)00214-5.

15.Makhija S, Baker J. The subjective global assessment: a review of its use in clinical practice[J]. Nutr Clin Pract, 2008, 23(4): 405-409. DOI: 10.1177/0884533608321214.

16.Grover Z, Burgess C, Muir R, et al. Early mucosal healing with exclusive enteral nutrition is associated with improved outcomes in newly diagnosed children with luminal Crohn's disease[J]. J Crohns Colitis, 2016, 10(10): 1159-1164. DOI: 10.1093/ecco-jcc/jjw075.

17.Pigneur B, Lepage P, Mondot S, et al. Mucosal healing and bacterial composition in response to enteral nutrition vs steroid-based induction therapy-a randomised prospective clinical trial in children with Crohn's disease[J]. J Crohns Colitis, 2019, 13(7): 846-855. DOI: 10.1093/ecco-jcc/jjy207.

18.Gerasimidis K, Nikolaou CK, Edwards CA, et al. Serial fecal calprotectin changes in children with Crohn's disease on treatment with exclusive enteral nutrition: associations with disease activity, treatment response, and prediction of a clinical relapse[J]. J Clin Gastroenterol, 2011, 45(3): 234-239. DOI: 10.1097/MCG.0b013e3181f39af5.

19.Grover Z, Muir R, Lewindon P. Exclusive enteral nutrition induces early clinical, mucosal and transmural remission in paediatric Crohn's disease[J]. J Gastroenterol, 2014. 49(4): 638-645. DOI: 10.1007/s00535-013-0815-0.

20.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[J]. Nutr Clin Pract, 2013, 28(4): 499-505. DOI: 10.1177/0884533613487218.

21.Lee D, Baldassano RN, Otley AR, et al. Comparative effectiveness of nutritional and biological therapy in North American children with active Crohn's disease[J]. Inflamm Bowel Dis, 2015, 21(8): 1786-1793. DOI: 10.1097/MIB. 0000000000000426.

22.Johnson T, Macdonald S, Hill SM, et al. Treatment of active Crohn's disease in children using partial enteral nutrition with liquid formula: a randomised controlled trial[J]. Gut, 2006, 55(3): 356-361. DOI: 10.1136/gut.2004.062554.

23.Wall CL, Gearry RB, Day AS. Treatment of active Crohn's disease with exclusive and partial enteral nutrition: a pilot study in adults[J]. Inflamm Intest Dis, 2018, 2(4): 219-227. DOI: 10.1159/000489630.

24.Stewart M, Day AS, Otley A. Physician attitudes and practices of enteral nutrition as primary treatment of paediatric Crohn disease in North America[J]. J Pediatr Gastroenterol Nutr, 2011, 52(1): 38-42. DOI: 10.1097/MPG.0b013e3181e2c724.

25.Yang H, Feng R, Li T, et al. Systematic review with meta-analysis of partial enteral nutrition for the maintenance of remission in Crohn's disease[J]. Nutr Res, 2020, 81: 7-18. DOI: 10.1016/j.nutres.2020.06.006.

26.Levine A, Wine E, Assa A, et al. Crohn's disease exclusion diet plus partial enteral nutrition induces sustained remission in a randomized controlled trial[J]. Gastroenterology, 2019, 157(2): 440-450.e8. DOI: 10.1053/j.gastro.2019.04.021.

27.Sigall Boneh R, Sarbagili Shabat C, Yanai H, et al. Dietary therapy with the Crohn's disease exclusion diet is a successful strategy for induction of remission in children and adults failing biological therapy[J]. J Crohns Colitis, 2017, 11(10): 1205-1212. DOI: 10.1093/ecco-jcc/jjx071.

28.李知翰, 王勇. 添加可溶性膳食纤维的肠内营养制剂对炎症性肠病患者肠道免疫平衡和肠道菌群的影响[J]. 黑龙江中医药, 2021, 50(1): 106-108. [Li ZH, Wang Y. Effects of enteral nutrition supplemented with soluble dietary fiber on intestinal immune balance and intestinal flora in patients with inflammatory bowel disease[J]. Heilongjiang Journal of Traditional Chinese Medicine, 2021, 50(1): 106-108.] https://d.wanfangdata.com.cn/periodical/ChlQZXJpb2RpY2FsQ0hJTmV3UzIwMjIwNDE1Eg9obGp6eXkyMDIxMDEwNzcaCDl2dGg2dzJ4.

29.Zachos M, Tondeur M, Griffiths AM. Enteral nutritional therapy for induction of remission in Crohn's disease[J]. Cochrane Database Syst Rev, 2007, (1): Cd000542. DOI: 10.1002/14651858.CD000542.pub2.

30.Rubio A, Pigneur B, Garnier-Lengliné H, et al. The efficacy of exclusive nutritional therapy in paediatric Crohn's disease, comparing fractionated oral vs. continuous enteral feeding[J]. Aliment Pharmacol Ther, 2011, 33(12):  1332-1339. DOI: 10.1111/j.1365-2036.2011.04662.x.

31.赵晓辉, 洪明, 路晓钦, 等. 经皮内镜下胃造口管及鼻饲管在克罗恩病肠内营养支持中的疗效比较 [J]. 实用临床医药杂志, 2014, 18(7): 124-126. [Zhao XM, Hong M, Lu XQ, et al. Effect comparison between percutaneous endoscopic gastrostomy and nasogastric feeding tube in enteral nutrition treatment of patients with Crohn's disease[J]. Journal of Clinical Medicine in Practice, 2014, 18(7): 124-126.] DOI: 10.7619/jcmp.201407042.

32.Jacobson S. Early postoperative complications in patients with Crohn's disease given and not given preoperative total parenteral nutrition[J]. Scand J Gastroenterol, 2012, 47(2):  170-177. DOI: 10.3109/00365521.2011.648954.

33.Yao GX, Wang XR, Jiang ZM, et al. Role of perioperative parenteral nutrition in severely malnourished patients with Crohn's disease[J]. World J Gastroenterol, 2005, 11(36): 5732-5734. DOI: 10.3748/wjg.v11.i36.5732.