Partial Enteral Nutrition in the Management of Crohn's Disease: A Systematic Review and Meta-Analysis.

Abstract

Background: Exclusive enteral nutrition is an established treatment for active Crohn's disease (CD) but the role of partial enteral nutrition (PEN) in the broader management of the disease is less clear. This systematic review and meta-analysis reviewed the literature on the role of PEN in CD management.

Methods: This review was conducted following Cochrane recommendations. The protocol was registered on PROSPERO. Findings were reported following the PRISMA guidelines.

Results: Sixty-four articles were identified, of which 11 reported data from randomised control trials. Good quality evidence suggests that PEN may be used as a maintenance and induction therapy, particularly at high dosages and/or alongside exclusion diets. A higher dosage of PEN is associated with a lower risk of subsequent disease relapse, with benefits observed at intakes above 35% of energy requirements (35-50% PEN: OR [95% CI]: 0.42 [0.27-0.65]; >50% PEN: OR [95% CI]: 0.27 [0.08-0.88]). Low quality evidence suggests that post-operative use of PEN may prevent disease recurrence or enhance treatment outcomes when used as adjunct therapy to biologics. PEN can improve nutritional parameters, showing efficacy comparable to EEN in paediatric patients (weight: OR [95% CI]: -0.04 [-0.32, 0.25]). The effect of PEN on improving patients' quality of life is comparable to that of EEN and anti-TNFα therapies.

Conclusion: Partial enteral nutrition may help in various aspects of CD management but much of the current evidence is of low quality. Well-designed RCTs are required to confirm findings from current literature and before clinical recommendations can be made.