Enteral nutritional therapy in Crohn disease complicated with incomplete intestinal obstruction / 中华胃肠外科杂志

ABSTRACT

<p><b>OBJECTIVE</b>To investigate the efficacy of enteral nutrition(EN) therapy for active Crohn disease(CD) complicated with incomplete intestinal obstruction.</p><p><b>METHODS</b>Clinical data of 37 patients with active CD complicated with incomplete intestinal obstruction treated with EN(n=37) between January 2003 and September 2009 were retrospectively analyzed. CD activity index (CDAI) was between 150 and 450. The patients received total enteral nutrition (TEN) 125 kJ/kg by nasogastric tube or percutaneous endoscopic gastrostomy/jejunostomy(PEG/J) tube. Clinical response was defined as a decrease in CDAI≥70 from baseline since EN therapy, and clinical remission was defined as CDAI<150. Nutritional status, disease activity index, and side effects were recorded at the 0, 4th, and 12th week after EN therapy.</p><p><b>RESULTS</b>Stricture or stenosis location included ileum in 8 (21.6%) patients, ileocolon in 19(51.4%), colon in 4(10.8%), jejunoileum in 5(13.5%), and duodenum in 1(2.7%). At 4 weeks after EN, CDAI significantly decreased(112.0±39.6 vs.174.6±34.7,P<0.05). The ratio of clinical response was 43.2%(16/37) and clinical remission was 72.9%(27/37). At 12 weeks, CDAI was 70.2±32.9, lower than that at week 4(P<0.05). The ratio of clinical response was 70.2%(26/37) and clinical remission was 78.4%(29/37). Other disease activity indexes such as C-reactive protein, erythrocyte sedimentation rate, and nutritional status such as BMI, serum albumin, prealbumin, transferrin and hemoglobin showed similar trend. During therapy, 7 cases had progressive intestinal obstruction resulting in bowel resection, 11 cases had diarrhea and/or abdominal distention due to inadequate infusion of home EN whose symptoms were improved after correction by the doctor.</p><p><b>CONCLUSIONS</b>EN therapy can induce clinical response and remission in CD complicated with incomplete intestinal obstruction, relieve obstruction, alleviate the inflammatory response which plays positive role in the treatment of CD.</p>