P342. The long-term efficacy of enteral nutrition for the prevention of postoperative recurrence in Crohn's disease: a five-year prospective cohort study
T. Yamamoto1, M. Shiraki1, S. Umegae1, K. Matsumoto1, 1Yokkaichi Social Insurance Hospital, Inflammatory Bowel Disease Centre, Yokkaichi, Japan
There has been only one prospective study evaluating the efficacy of enteral nutrition (EN) for patients with Crohn's disease (CD) in the postoperative setting, which was conducted at our institution. Therefore, the efficacy of EN for maintaining surgically induced remission remains unknown. This study was to investigate the long-term effect of EN as maintenance therapy in CD patients following surgery.
This study was an extension of our previous study to prolong the duration of intervention and follow-up from 1 year to 5 years. Forty consecutive patients who underwent resection for ileal or ileocolic CD were included. Following surgery, 20 patients received continuous elemental diet infusion during the nighttime plus a low-fat diet during the daytime (EN group). Another 20 patients received neither nutritional therapy nor food restriction (control group). All patients were followed for 5 years after operation. No patient received corticosteroid, immunosuppressants or infliximab except patients who developed recurrence. The endpoint of this study was recurrence requiring biologic therapy or reoperation. Recurrence rates were analyzed on an intention-to-treat basis.
Patients in the EN and the control groups were well matched with respect to age, sex, duration of CD before surgery, smoking history, previous surgical treatment, disease location, indication for surgery and preoperative medications. In the EN group, 4 patients could not continue tube intubation for elemental diet intake. Two patients (10%) in the EN group and 9 patients (45%) in the control group developed recurrence requiring infliximab therapy (P = 0.03). The cumulative recurrence incidence rate requiring infliximab was significantly lower in the EN group vs the control group (P = 0.02). One patient (5%) in the EN group and 5 patients (25%) in the control group required reoperation for recurrence (P = 0.18). The cumulative incidence of reoperation was lower in the EN group vs the control group, the difference not being significant (P = 0.08).
The outcomes of this study suggest that EN therapy reduces the incidence of postoperative CD recurrence.