Treatment by enteral nutrition in inflammatory bowel disease.

Exclusive enteral nutrition remains an important therapy in children and adolescents with Crohn's disease. Despite the lack of large randomised trials, a number of prospective cohort studies document the efficacy of this therapy. In addition, the evidence that exclusive enteral nutrition as therapy is able to achieve mucosal healing is well established. However, to achieve a clinical remission in around 80% of children requires a multi-disciplinary team of committed dieticians, nurses and physicians to support the child and family. It is also clear that poor compliance or partial enteral nutrition does not lead to the anti-inflammatory effects seen with exclusive enteral nutrition. The ability to offer an effective alternative to corticosteroids for remission induction in acute Crohn's disease also minimises a further negative impact on growth. The use of immunosuppressants (i.e. thiopurines) earlier in the course of disease provides an ideal opportunity for a course of exclusive enteral nutrition to induce remission while awaiting the delayed benefits of thiopurine activity. Until it is possible to better predict which patients will have a severe disease course and therefore might warrant a 'top-down' approach, exclusive enteral nutrition remains an effective, efficacious and side-effect-free therapy to induce mucosal healing and clinical remission in patients with active Crohn's disease. Copyright (C) 2009 S. Karger AG, Basel