Practical aspects of enteral nutrition in the management of Crohn's disease.

BACKGROUND

Enteral nutrition regimens achieve remission from active Crohn's disease at rates comparable to steroids and total parenteral nutrition. Despite their increasing use there has to date been no assessment of patient tolerance or practical difficulties involved.

METHODS

We investigated 147 treatments with elemental diet in 89 patients and followed this with an anonymous questionnaire.

RESULTS

Sip feeding was successfully introduced in 85% with nasogastric feeding being necessary in 22 (15%). Nausea and postural hypotension were common in the first week of treatment but vomiting was only seen in three patients who were sensitive to the formula used. Two patients each had caffeine withdrawal symptoms and hypoglycemia and a further four had food-related night terrors. Our experience suggests that caution is necessary if this treatment is used in elderly subjects. Although the diets are perceived as being unpalatable, only six patients found taste to be a problem after the first week of treatment. The main problem with long-term treatment was the large daily volume requirement, which was overcome by increasing the concentration of the feed. Eighty percent of patients responded to the questionnaire, and 65% stated that they would opt for treatment with elemental diet again in the case of a further relapse.

CONCLUSIONS

Elemental diet seems to be an acceptable and well-tolerated form of treatment in Crohn's disease.