Enteral Nutrition in Crohn's disease -Factors Influencing Induction of Remission-

Abstract

Enteral nutrition (EN) has been shown to control the activity of Crohn's disease. Therefore, the purpose of this study was to clarify factors influencing the induction of remission.
From 1985 to 1992, 87 active patients (25 ileitis, 31 ileocolitis, 11 colitis, 17 ileocolostomies, and 3 with only aphthoid lesions) treated with EN were analyzed. These 87 patients were divided into two groups (67 patients with remission and 20 patients without) based on clinical response to the treatment. Remission was defined as CDAI<150 and ESR <20 mm/hr. after 4weeks of treatment. Clinical characteristics and radiographic findings (scored severity of the findings) were compared between the two groups. Furthermore, multiple logistic regression analysis was performed to clarify the relative importance of various clinical or radiographic factors associated with remission.
Remission rate at 4weeks with EN was 77%. From multiple variable analysis using 11 factors which were significant by single valuable analysis, only four factors (times of previous nutrition therapy, melena, high level of CDAI, and severe cobblestone appearance of the large intestine) were selected as significant valuable factors.
From the above-mentioned results, it was concluded that patients, who underwent frequent nutritional therapies, had severe clinical activity, and had severe colonic lesions tended to be resistant to enteral nutrition. Both clinical and radiographic features are important prognostic factors in predicting response to nutritional therapy.