Enteral nutrition for the maintenance of remission in Crohnʼs disease: a systematic review

OBJECTIVEThis review study was designed to evaluate the efficacy of enteral nutrition (EN) for the maintenance of remission in patients with Crohnʼs disease (CD) who achieved medically or surgically induced remission. METHODSThe Medline, Embase, Ovid, and Cochrane database search of literature was carried out to identify studies that reported the efficacy of EN for the maintenance of remission in CD. The main outcome measure was the occurrence of clinical or endoscopic relapse. RESULTSTen studies were includedone randomized controlled trial, three prospective non-randomized trials, and six retrospective studies. Elemental, semielemental or polymeric diets were used as an oral supplement or a nocturnal tube feeding in addition to ordinary foods. Comparing outcomes between patients who received EN and those who did not, the clinical remission rate was significantly higher in those with EN in all seven studies. In two studies, EN showed suppressive effects on endoscopic disease activity. In all four studies investigating impacts of the quantity of enteral formula on clinical remission, higher amounts of enteral formula were associated with higher remission rates≥30 kcal/kg ideal body weight/day (vs.