Inflammatory Bowel Disease Center and Department of Surgery, Yokkaichi Social Insurance Hospital, 10-8 Hazuyamacho, Yokkaichi, Mie 510-0016, Japan.
Int J Colorectal Dis. 2013 Mar;28(3):335-40. doi: 10.1007/s00384-012-1587-3. Epub 2012 Sep 27.
The aim of this study was to investigate the long-term effect of enteral nutrition (EN) as a maintenance therapy in Crohn's disease (CD) patients following surgery.
This study was an extension of our previous study to prolong the duration of intervention and follow-up from 1 to 5 years. Forty consecutive patients who underwent resection for ileal or ileocolic CD were included. Following surgery, 20 patients received continuous elemental diet infusion during the nighttime plus a low-fat diet during the daytime (EN group). Another 20 patients received neither nutritional therapy nor food restriction (control group). All patients were followed for 5 years after operation. No patient received corticosteroid, immunosuppressants, or infliximab except patients who developed recurrence. The end point of this study was recurrence requiring biologic therapy or reoperation. Recurrence rates were analyzed on an intention-to-treat basis.
In the EN group, four patients could not continue tube intubation for elemental diet intake. Two patients (10 %) in the EN group and nine patients (45 %) in the control group developed recurrence requiring infliximab therapy (P = 0.03). The cumulative recurrence incidence rate requiring infliximab was significantly lower in the EN group vs the control group (P = 0.02). One patient (5 %) in the EN group and five patients (25 %) in the control group required reoperation for recurrence (P = 0.18). The cumulative incidence of reoperation was lower in the EN group vs the control group, the difference not being significant (P = 0.08).
The outcomes of this study suggest that EN therapy reduces the incidence of postoperative CD recurrence.
本研究旨在探讨术后克罗恩病（CD）患者进行肠内营养（EN）维持治疗的长期效果。
这是我们之前研究的延续，将干预和随访时间从 1 年延长至 5 年。纳入 40 例接受回肠或回结肠 CD 切除术的连续患者。术后，20 例患者夜间持续输注要素饮食，白天给予低脂肪饮食（EN 组）。另 20 例患者既不接受营养治疗也不限制饮食（对照组）。所有患者术后均随访 5 年。除发生复发的患者外，所有患者均未接受皮质类固醇、免疫抑制剂或英夫利昔单抗治疗。本研究的终点为需要生物治疗或再次手术的复发。采用意向治疗分析复发率。
EN 组中有 4 例患者因要素饮食摄入无法继续进行管饲。EN 组中有 2 例（10%）和对照组中有 9 例（45%）患者发生需要英夫利昔单抗治疗的复发（P = 0.03）。EN 组比对照组需要英夫利昔单抗治疗的累积复发发生率显著降低（P = 0.02）。EN 组中有 1 例（5%）和对照组中有 5 例（25%）患者因复发需要再次手术（P = 0.18）。EN 组再次手术的累积发生率低于对照组，但差异无统计学意义（P = 0.08）。
本研究结果表明，EN 治疗可降低术后 CD 复发的发生率。
