Management of Crohn's disease: time for audit?

Nutritional management of inflammatory bowel disease

The etiology and specific treatment of Crohn's disease and ulcerative colitis are unknown, and the treatment strategy for patients with inflammatory bowel disease is essentially symptomatic and supportive. The malnutrition that frequently accompanies inflammatory bowel disease is a manifestation of intestinal failure and should be vigorously corrected with total parenteral nutrition, elemental diets, or both. Evidence exists for the value of total parenteral nutrition and elemental diets as primary therapy for inflammatory bowel disease in selected patients. Judicious nutritional therapy remains a cornerstone in the adjunctive management of these patients.

Comparison of total parenteral nutrition and elemental diet in induction of remission of Crohn's disease. Long-term maintenance of remission by personalized food exclusion diets

Total parenteral nutrition or elemental diet can be used to induce remission of Crohn's disease. A randomized study has been conducted of 36 patients to assess the relative efficacy of the two techniques used without pharmacologic support; both were successful, and no significant differences emerged in the number of days to remission or the mean changes in Crohn's disease activity index, erythrocyte sedimentation rate, or serum albumin. The elemental diet is cheaper, simpler and safer. Uncontrolled clinical experience with 77 patients showed that personalized food exclusion diets were associated with an average annual relapse rate of only 11% for the first five years of diet alone; there have been six pregnancies and the longest remission is now 75 months. The use of elemental diet followed by the development of a personal food exclusion diet appears to be an effective long-term therapeutic strategy for Crohn's disease.