Inflammatory Bowel Disease Center, Yokkaichi Social Insurance Hospital, Yokkaichi, 10-8 Hazuyamacho, Yokkaichi, Mie 510-0016, Japan.
Eur J Gastroenterol Hepatol. 2010 Jan;22(1):1-8. doi: 10.1097/MEG.0b013e32832c788c.
This review study was designed to evaluate the efficacy of enteral nutrition (EN) for the maintenance of remission in patients with Crohn's disease (CD) who achieved medically or surgically induced remission.
The Medline, Embase, Ovid, and Cochrane database search of literature was carried out to identify studies that reported the efficacy of EN for the maintenance of remission in CD. The main outcome measure was the occurrence of clinical or endoscopic relapse.
Ten studies were included: one randomized controlled trial, three prospective non-randomized trials, and six retrospective studies. Elemental, semielemental or polymeric diets were used as an oral supplement or a nocturnal tube feeding in addition to ordinary foods. Comparing outcomes between patients who received EN and those who did not, the clinical remission rate was significantly higher in those with EN in all seven studies. In two studies, EN showed suppressive effects on endoscopic disease activity. In all four studies investigating impacts of the quantity of enteral formula on clinical remission, higher amounts of enteral formula were associated with higher remission rates: > or =30 kcal/kg ideal body weight/day (vs. <30 kcal/kg ideal body weight/day), > or =1200 kcal/day (vs. <1200 kcal/day), and > or =1600 kcal/day (vs. <1600 kcal/day). Quantitative pooling of studies was not feasible because of the diversity of interventions and outcome measures among the studies.
Although the evidence level is not high, the available data suggest that EN may be useful for maintaining remission in patients with CD. Large randomized controlled trials are necessary to assess a definite efficacy of EN for the maintenance of remission.
本综述研究旨在评估肠内营养（EN）在实现医学或手术诱导缓解的克罗恩病（CD）患者中维持缓解的疗效。
对 Medline、Embase、Ovid 和 Cochrane 数据库进行文献检索，以确定报告 EN 对 CD 维持缓解疗效的研究。主要观察指标为临床或内镜复发。
纳入了 10 项研究：1 项随机对照试验、3 项前瞻性非随机试验和 6 项回顾性研究。采用要素、半要素或聚合物饮食作为口服补充剂或夜间管饲，同时添加普通食物。比较接受 EN 和未接受 EN 的患者的结局，在所有 7 项研究中，EN 组的临床缓解率明显更高。EN 在 2 项研究中显示出对内镜疾病活动的抑制作用。在 4 项研究中，对肠内配方的数量对临床缓解的影响进行了调查，较高数量的肠内配方与更高的缓解率相关：≥30 kcal/kg 理想体重/天（vs. <30 kcal/kg 理想体重/天），>1200 kcal/天（vs. <1200 kcal/天）和>1600 kcal/天（vs. <1600 kcal/天）。由于研究之间干预和结局指标的多样性，无法对研究进行定量汇总。
尽管证据水平不高，但现有数据表明，EN 可能对维持 CD 患者的缓解有帮助。需要进行大型随机对照试验来评估 EN 对维持缓解的确切疗效。
