Lee J, Allen R, Ashley S, Becker S, Cummins P, Gbadamosi A, Gooding O, Huston J, Le Couteur J, O'Sullivan D, Wilson S, Lomer M C E
Department of Nutrition and Dietetics, Addenbrookes, Cambridge, UK.
J Hum Nutr Diet. 2014 Jun;27(3):207-18. doi: 10.1111/jhn.12176. Epub 2013 Dec 6.
Crohn's disease is a debilitating chronic inflammatory bowel disease. Appropriate use of diet and nutritional therapy is integral to the overall management strategy of Crohn's disease. The aim was to develop evidence-based guidelines on the dietary management of Crohn's disease in adults.
Questions relating to the dietary management of Crohn's disease were developed. These included the roles of enteral nutrition to induce remission, food re-introduction diets to structure food re-introduction and maintain remission, and dietary management of stricturing disease, as well as whether probiotics or prebiotics induce or maintain remission. A comprehensive literature search was conducted and relevant studies from January 1985 to November 2009 were identified using the electronic database search engines CINAHL, Cochrane Library, EMBASE, MEDLINE, Scopus and Web of Science. Evidence statements, recommendations, practical considerations and research recommendations were developed.
Fifteen research papers were critically appraised and the evidence formed the basis of these guidelines. Although corticosteroids appear to be more effective, enteral nutrition (elemental or non-elemental) can be offered as an alternative option to induce disease remission. After a course of enteral nutrition, food re-introduction diets may be useful to structure food re-introduction and help maintain disease remission. Dietary fibre is contraindicated in the presence of strictures as a result of the risk of mechanical obstruction. The use of probiotics and prebiotics is not currently supported.
As an alternative to corticosteroids, evidence supports enteral nutrition to induce disease remission. Food re-introduction diets provide structure to food re-introduction and help maintain disease remission. These guidelines aim to reduce variation in clinical practice.
克罗恩病是一种使人衰弱的慢性炎症性肠病。合理使用饮食和营养疗法是克罗恩病整体管理策略的组成部分。目的是制定关于成人克罗恩病饮食管理的循证指南。
提出了与克罗恩病饮食管理相关的问题。这些问题包括肠内营养在诱导缓解中的作用、用于构建食物重新引入和维持缓解的食物重新引入饮食、狭窄性疾病的饮食管理，以及益生菌或益生元是否能诱导或维持缓解。进行了全面的文献检索，使用电子数据库搜索引擎CINAHL、Cochrane图书馆、EMBASE、MEDLINE、Scopus和科学网确定了1985年1月至2009年11月的相关研究。制定了证据陈述、建议、实际考虑因素和研究建议。
对15篇研究论文进行了严格评估，这些证据构成了这些指南的基础。虽然皮质类固醇似乎更有效，但肠内营养（要素或非要素）可作为诱导疾病缓解的替代选择。经过一个疗程的肠内营养后，食物重新引入饮食可能有助于构建食物重新引入并帮助维持疾病缓解。由于存在机械性梗阻的风险，在有狭窄的情况下禁用膳食纤维。目前不支持使用益生菌和益生元。
作为皮质类固醇的替代方法，证据支持肠内营养诱导疾病缓解。食物重新引入饮食为食物重新引入提供了框架，并有助于维持疾病缓解。这些指南旨在减少临床实践中的差异。
