Enteral nutrition and total parenteral nutrition in Crohn's disease ; factors influencing induction of remission

Abstract

The aim of this study was to clarify factors influencing the induction of remission and to compare the short term remission rate of EN with that of TPN. From 1985 to 1992, 87 active patients treated for more than 4 weeks with EN and 71 active patients treated with TPN were analysed. Excluding the case with severe complications (abdominal abscess, external fistula, sub-ileus), 132 patients were divided to two groups (patients with remission and non-remission) based on clinical response to the treatment. Remission was defined as Crohn's disease activity index (CDAI) <150 and ESR < 20mm/hr after 4 weeks of treatment. Clinical characteristics and radiographic findings were compared between the two groups. Furthermore, a multiple logistic regression analysis was performed to clarify the relative importance of various clinical or radiographic factors associated with remission. Remission rate at four weeks with EN was 77% and that with TPN was 62%. By a multiple logistic regression analysis using 15 factors, which were significant by a single variable analysis, four factors (times of previous nutritional treatment, IOIBD, WBC, polyposis score of the colon) in EN cases and three factors (ESR, platelets, extent of Crohn's disease) in TPN cases were selected as independent prognostic factors after adjusting for the effect of other factors. Moreover, mode of therapy was not selected as a valuable factor. From the above mentioned results, it was concluded that EN and TPN were equivalent in the efficacy of short-term therapy and patients having had several previous nutritional therapy, high IOIBD score, high WBC count, severe cobblestoning of the colon were tended to be resistant to EN therapy and high ESR value, high platelet count, broader extent of Crohn's disease were tended to be resistant to TPN therapy. Both clinical and radiographic features are important prognostic factors in predicting response to nutritional therapy.