Ohara Nobuyoshi, Mizushima Tsunekazu, Iijima Hideki, Takahashi Hidekazu, Hiyama Satoshi, Haraguchi Naotsugu, Inoue Takahiro, Nishimura Junichi, Shinzaki Shinichiro, Hata Taishi, Matsuda Chu, Yamamoto Hirofumi, Doki Yuichiro, Mori Masaki
Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan.
Department of Therapeutics for Inflammatory Bowel Diseases, Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan.
Surg Today. 2017 Dec;47(12):1519-1525. doi: 10.1007/s00595-017-1543-5. Epub 2017 May 22.
An elemental diet (ED) can suppress inflammation in patients with Crohn's disease (CD); however, adherence to this diet is difficult. We examined the correlation between ED adherence and the postoperative recurrence of CD.
The subjects of this study were 38 patients who underwent intestinal resection with anastomosis. We defined ED adherence as consuming the average daily ED dose (≥900 kcal/day) for 2 years after surgery. Patients who did not adhere to the ED were allocated to the non-ED group. We diagnosed symptomatic recurrence using the CD activity index and endoscopic recurrence using the Rutgeerts' score.
The ED and non-ED groups comprised 21 and 17 patients, respectively, with ED adherence of 55.3% (21/38). At the initial endoscopy, symptomatic and endoscopic recurrence rates were 4.8 and 14.3%, respectively, in the ED group, and 23.5 and 41.2%, respectively, in the non-ED group (P = 0.152 and P = 0.078, respectively). The overall symptomatic recurrence-free duration was significantly longer than the endoscopic recurrence-free duration (P = 0.022). Symptomatic and endoscopic recurrence-free durations were longer in the ED group than in the non-ED group (P = 0.003 and P = 0.021, respectively), and ED adherence was a prognostic factor for endoscopic recurrence (HR = 2.777, 95% CI = 1.036-8.767, P = 0.042).
Maintaining ED adherence for 2 years after surgery improved the symptomatic and endoscopic recurrence-free durations.
要素饮食（ED）可抑制克罗恩病（CD）患者的炎症；然而，坚持这种饮食很困难。我们研究了要素饮食依从性与CD术后复发之间的相关性。
本研究的对象为38例行肠切除吻合术的患者。我们将要素饮食依从性定义为术后2年每天摄入平均要素饮食剂量（≥900千卡/天）。未坚持要素饮食的患者被分配到非要素饮食组。我们使用CD活动指数诊断症状性复发，使用 Rutgeerts评分诊断内镜复发。
要素饮食组和非要素饮食组分别有21例和17例患者，要素饮食依从率为55.3%（21/38）。在初次内镜检查时，要素饮食组的症状性和内镜复发率分别为4.8%和14.3%，非要素饮食组分别为23.5%和41.2%（P分别为0.152和0.078）。总体无症状复发持续时间显著长于无内镜复发持续时间（P = 0.022）。要素饮食组的症状性和无内镜复发持续时间长于非要素饮食组（P分别为0.003和0.021），要素饮食依从性是内镜复发的一个预后因素（HR = 2.777，95%CI = 1.036 - 8.767，P = 0.042）。
术后维持要素饮食依从性2年可改善症状性和无内镜复发持续时间。
