P612 Exclusive enteral nutrition in adults with active Crohn's disease is associated with decreased disease activity

Abstract

Introduction: Exclusive Enteral Nutrition (EEN) induces clinical remission in ∼70% of children and adolescents with active Crohn's disease (CD), and is comparable to steroids Aims and Methods: We aimed to evaluate the impact of EEN in adults with active CD. Patients with active CD referred for nutritional intervention in a tertiary inflammatory bowel disease (IBD) center, were enrolled. Baseline weight and nutritional needs were recorded. EEN recommended for induction of remission by an IBD nutritionist was administered by oral polymeric formula with no other food items allowed. Patients were treated for at least three weeks. Physician's Global assessment (PGA), Harvey Bradshaw Index (HBI), biomarkers (blood count, C-reactive protein [CRP], and albumin), weight, and body mass index (BMI) were recorded at baseline and at the end of the EEN course. Results: A total of 37/50 patients (74%) with active CD completed a full EEN course. Sixteen patients (32%) had newly diagnosed CD (<1.5 years); male/ female 31/19; mean age: 33.2±9.9 years; median disease duration 10.4±9.8 years (range 0-36 years). Montreal classification: L1-17 (34%), L2- 4 (8%), L3 -29 (58%); B1-22 (43%), B2 -16 (32%), B3 -7 (14%); P- 11 (22%). Disease severity by PGA at baseline was: 9-mild, 28-moderate, 13-severe disease. Mean EEN duration was 5.4 weeks (range 3-16). Significant improvement in activity indices was observed after EEN: HBI 7.17±4.7 vs 2.46±2.7 (p<0.001); median CRP 4.4±5.2 (IQR 1.23-5.5) mg/dl vs 1.01±1.4 (IQR 0.39-1.01) mg/dl (p<0.001); mean albumin 3.78±0.6 mg/l vs 4.24±0.45 mg/l (p=0.002) WBC 9.73±4.07 vs 7.9±3.07 (p=0.047). There was no change in weight or BMI during EEN course. Patients with long-standing CD (n=25) also experienced significant improvement in activity indices after EEN: HBI decreased from 5.64±5.1 to 2.89±3.24 (p<0.001); CRP from 4.43±5.51 (IQR 1.28-5.63) mg/dl to 1.06±1.45 (IQR 0.5-1.2) mg/dl (p=0.004), and albumin increased from 3.75±0.54 to 4.28±0.37 (p=0.004). A trend for improvement in disease activity was apparent also in the 20 patients who received EEN as an add- on therapy to stable doses of their baseline therapy: HBI decreased from 7.54±5.5 to 2.56±3.0 (p<0.001) and CRP decreased from 4.44±6 (IQR 1.07-5.35) mg/dl to 0.96±1.4 (IQR 0.45-0.64) mg/dl (p=0.009). Albumin increased from 3.72±0.68 to 4.1±0.43 ( p=0.021), and hemoglobin increased from 12.6±2.0 gr/dl to 13.4±1.4 gr/dl (p=0.033). Conclusion: EEN is an effective nutritional intervention in adults with active CD. EEN is associated with decreased clinical and biologic inflammatory activity, and may be beneficial in patients with newly diagnosed, as well as long-standing CD. EEN may may be a bridge or an add-on induction treatment in patients who flare on stable treatments.