P375 Efficacy of Exclusive Enteral Nutrition (EEN) in Active Crohn’s Disease with Complications or Failure of Medical Treatment
Q. Yang*1, X. Gao1, M. Zhi1, H. Chen1, N. Ding1, S. Hu2, J. Guo1, P. Hu1
1The Sixth Affiliated Hospital of Sun Yat-sen University(Guangdong Gastrointestinal Hospital), Department of Gastroenterology, Guangzhou, China, 2The Sixth Affiliated Hospital of Sun Yat-sen University (Guangdong Gastrointestinal Hospital), Department of Gastroenterology, Guangzhou, China
Complicated active Crohn’s disease (CD) patients may not need emergent surgery or not be suitable for surgery due to malnutrition. They may also not be appropriate for corticosteroids or biologics due to stricture, intestinal fistula and/or abdominal abscess. Some patients had poor response to medical therapy. We aim to investigate the efficacy of EEN in induction of remission in active CD patients with complications or poor response to drugs.
Active CD patients who had been diagnosed as complicated disease with stricture, intestinal fistula, abdominal abscess and/or no response to drugs, were recruited since July 2013 to November 2014. Patients were offered EEN. Nutritional markers and high sensitivity C-reactive protein (hs-CRP) were evaluated at baseline, week 4, and week 8, respectively. Disease activity was assessed by the Harvey-Bradshaw index.
20 patients (7 female and 13 male, mean ages 26.1 ± 12.97) were involved. 5 patients were no response to drugs; 13 patients accompanied with complications and 2 patients exhibited both of these two characteristics. 3 patients were further excluded because of intolerance to EEN. Of the remaining 17 patients, 2 patients had no improvement and 1 of them stopped EEN 4 weeks later; the other 15 achieved clinical remission in 4 weeks (CDAI before EEN 6.2 ± 2.0 vs. EEN by 4weeks 2.9 ± 1.2, P=0.001). After 8 weeks, 14 were kept in remission (CDAI before EEN 6.2 ± 2.0 vs. EEN by 8 weeks 2.5 ± 1.2, P=0.000) while 2 patients were transferred to surgery due to progressive bowel obstruction. After EEN, BMI of these patients increased significantly (before EEN16.3 ± 1.89 vs. EEN by 8 weeks 17.8 ± 1.85, P=0.031). By 4 weeks, hs-CRP was significantly decreased compared to baseline (12.1 ± 4.45 vs. 6.1 ± 4.64, P=0.001). 6 patients who complicated with intestinal fistula or abdominal abscess performed colonoscopy and Magnetic Resonance Elastography (MRE) after EEN treatment for 8 weeks. The Simple Endoscopic Score for Crohn’s Disease (SES-CD) was decreased significantly (before EEN7 ± 1.67 vs. EEN by 8 weeks 2.8 ± 1.60, P=0.001); three patients (50%) reached mucosal healing and the abscess/ fistula disappeared in 2 of the 6 patients.
EEN is effective for inducing early clinical remission to active CD patients with complications and/or poor response to drugs. Large prospective study needed to further confirm this conclusion.