Max Rady College of Medicine, Department of Medicine, Section of Gastroenterology, University of Manitoba, St. Boniface Hospital, Winnipeg, MB R2H 2A6, Canada.
Nutrients. 2018 Apr 26;10(5):537. doi: 10.3390/nu10050537.
Genetic and environmental factors are thought to profoundly influence the pathophysiology of Crohn’s disease (CD). Changes in dietary and hygiene patterns affect the interactions between the immune system and environment. The gut microbiome is responsible for mediating host immune response with significant dysbiosis observed in individuals with CD. Diet therapy using exclusive enteral nutrition (EEN) has been studied as primary therapy for the management of CD. EEN may cultivate the presence of beneficial microbiota, improve bile acid metabolism, and decrease the number of dietary microparticles possibly influencing disease and immune activity. In this review, we will address the current evidence on EEN in the management of adult and pediatric CD. In adults, EEN appears to be moderately beneficial for the induction of remission of CD; however, its use is understudied and underutilized. Stronger evidence is in place to support the use of EEN in pediatric CD with the added benefit of nutrition support and steroid-sparing therapy during the growth phase. Overall, EEN is an established therapy in inducing CD remission in the pediatric population while its role as primary therapy of adult Crohn’s disease remains to be defined.
遗传和环境因素被认为对克罗恩病（CD）的病理生理学有深远影响。饮食和卫生模式的变化会影响免疫系统与环境之间的相互作用。肠道微生物组负责调节宿主的免疫反应，在 CD 患者中观察到明显的微生物失调。使用完全肠内营养（EEN）的饮食疗法已被研究作为 CD 管理的主要治疗方法。EEN 可能会培养有益微生物群的存在，改善胆汁酸代谢，并减少可能影响疾病和免疫活动的饮食微粒的数量。在这篇综述中，我们将讨论 EEN 在成人和儿童 CD 管理中的现有证据。在成人中，EEN 似乎对诱导 CD 缓解有一定的益处；然而，它的使用研究不足，也未得到充分利用。有更强的证据支持在儿科 CD 中使用 EEN，它具有营养支持和在生长阶段类固醇节省治疗的额外益处。总的来说，EEN 是诱导儿科 CD 缓解的既定疗法，而其作为成人克罗恩病的主要治疗方法的作用仍有待确定。
