Enteral Therapy as a treatment for Crohn’s disease

[Editor’s note: This article was originally published in CIRCLE May-June 2013]

Enteral therapy refers to providing nutrition as a formula rather than by eating a regular diet. Enteral therapy has been shown to be effective in inducing, and perhaps maintaining, remission for pediatric patients with Crohn’s disease. Enteral therapy does not have the side effects seen with drug treatment, and can improve growth, unlike corticosteroids, which have many known side effects. Although used very little in the United States, enteral therapy is commonly used abroad, including many European countries and Japan.

Over the years, several methods of administering enteral therapy have been evaluated, leading to variation in treatment. In 2012, the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) formed the Enteral Nutrition Working Group to review the use of enteral nutrition therapy in pediatric Crohn’s disease, which summarized previous research and offered recommendations for physicians.

Drinking FormulaHistorically, enteral therapy was given through a feeding tube, and this is still done at many centers. However, drinking the formula is also an effective option. Studies have used both specialized nutrition formulas (in which the protein has been broken down to into smaller pieces) and non-prescription over-the-counter formulas (in which protein is not broken down). Both approaches appear to be equally effective, an important finding since over-the-counter formulas taste better and are less expensive.

The majority of the research has shown that enteral therapy is effective when taken as the sole source of nutrition (that means the patient can’t eat any food), and this approach was recommended by the NASPGHAN Enteral Nutrition Working Group. However, recently a study published by Children’s Hospital of Philadelphia showed that enteral therapy protocol is still effective when a small amount of food (less than 20% of the calories) is taken at the same time.

The way enteral therapy works is unclear. Theories include that it may help to provide the body with important nutrients and better overall nutrition, eliminate an unknown dietary substance that causes an immune response, or alter the bacteria found in the intestines.

A perceived barrier to enteral therapy is that the treatment may be demanding for physicians, families, and patients. For example it may be difficult to start, expensive, create a need for a feeding tube, or be displeasing to patients. Nationwide Children’s Hospital is developing and testing a simple enteral therapy protocol which could be started very quickly and could be used at other GI centers. They plan to work with families and patients to reduce the perceived barriers via education on cost issues and payment options, and by developing a mentoring program. If successful, the protocol could significantly decrease the number of newly diagnosed patients with Crohn’s disease who are initially treated with corticosteroids. Stay tuned.

Jen Smith, MS, RD, LD, LMT, Clinical Dietitian
Nationwide Children’s Hospital, Columbus, Ohio

4 thoughts on “Enteral Therapy as a treatment for Crohn’s disease

  1. Reblogged this on LOOP and commented:

    If you want to get the basics on Enteral Therapy as a treatment for Crohn’s disease, check out this repost of a 2014 blog by Jen Smith of Nationwide Children’s. If you’re interested in learning more about how ImproveCareNow team members are experiencing Exclusive Enteral Nutrition for themselves – to better understand some of the challenges and opportunities – you might want to consider following @JonMosesMD, @HaleyNeef and @UMkidsIBD on Twitter. Also, please follow us here on LOOP, where we’ll continue the conversation by sharing EEN stories from teams and community members, and highlighting co-produced tools support systems for EEN.

  2. Pingback: The Year We Became a Community | LOOP

  3. My son is doing this and so far he has had great results, gained weight and is well adjusted to having this new disease. It is not without struggles but, they are worth it for him. As a family, we have all changed our eating habits and are a lot more thoughtful. We dont eat in front of him and we all drink protein drinks in place of some of our food. We can sit down at the table with a drink and play games instead of passing the salt. Socially, things have changed because it is hard to go anywhere without food being the center of attention. We save his 5-10% of food intake for the times when he goes out. He knows he cannot have a meal per se but savors the food he can have with small bites. We have all learned not to take the small pleasures in life for granted and are closer for it. Adversity can have advantages…if you look hard or create them yourself. This goes for any kind of treatment…its about resiliency and teaching our kids how to embrace it.
    For anyone out there wanting to try or needing to use this method, I want to encourage you that it can at least be attempted and maybe successful if everyone is behind the treatment.

  4. Thanks for sharing this article as a LOOP post. So many of the ICN centers have an increased focus on enteral nutrition right now, so this is a great reminder. Since this was originally published, a number of centers have tested the protocol that Nationwide ended up developing and it is being spread as ICN’s first clinical pathway. The growing and dynamic RD group is also taking on a more visible role in these issues and I’m anxious to hear more from them on these topics in the coming months!

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