Heuschkel Robert
Department of Paediatric Gastroenterology, Hepatology and Nutrition, Addenbrookes Hospital, Cambridge University Hospital, Cambridge CB2 0QQ, UK.
Dig Dis. 2009;27(3):297-305. doi: 10.1159/000228564. Epub 2009 Sep 24.
Exclusive enteral nutrition has been used over many years as a therapy to try and achieve a remission in adults and children presenting with acute Crohn's disease. Despite its reported efficacy at achieving clinical responses in excess of 80% in some case series, it has not been taken up widely as a first-line therapy. This is, at least in part, due to the lack of a large prospective randomised study.
The literature is replete with small case series and anecdotal reports from units who use this therapy. Recent literature is reviewed on efficacy, application, composition and potential mechanisms of action of this therapy.
Although the evidence base remains quite limited, further data are available that suggest a clear benefit of exclusive enteral nutrition as an efficacious alternative to steroid therapy at inducing a clinical remission in Crohn's disease. Certain sub-groups are likely to benefit more, with potential benefits on growth making it particularly useful in adolescents and growing young adults. Given the lack of side effects compared to the alternative of steroid therapy, along with the clear nutritional benefits of this therapy, it remains an obvious choice for patients presenting with Crohn's disease and a degree of malnutrition.
This therapy should remain a first-line therapy for children and adults presenting with mild to moderate Crohn's disease.
多年来，全肠内营养一直被用作一种治疗方法，试图使患有急性克罗恩病的成人和儿童实现病情缓解。尽管在一些病例系列报道中，其在实现临床反应方面的疗效超过80%，但它尚未被广泛用作一线治疗方法。这至少部分是由于缺乏大型前瞻性随机研究。
文献中充斥着使用这种治疗方法的单位的小病例系列和轶事报告。对近期关于这种治疗方法的疗效、应用、成分和潜在作用机制的文献进行综述。
尽管证据基础仍然相当有限，但有更多数据表明，全肠内营养作为一种有效的替代类固醇疗法，在诱导克罗恩病临床缓解方面具有明显益处。某些亚组可能受益更多，其对生长的潜在益处使其在青少年和正在成长的年轻人中特别有用。鉴于与类固醇疗法相比缺乏副作用，以及这种疗法明显的营养益处，对于患有克罗恩病和一定程度营养不良的患者来说，它仍然是一个显而易见的选择。
这种治疗方法应仍然是患有轻至中度克罗恩病的儿童和成人的一线治疗方法。
