Early therapeutic benefit of enteral nutrition in active Crohn disease

This study was designed to test the hypothesis that enteral nutrition (EN) provides an early therapeutic benefit in Crohn disease (CD) by improving intestinal barrier functions and decreasing inflammation. Twenty-one adult patients with active CD were enrolled for treatment with total EN therapy for 6 weeks. Serum levels of C-reactive protein, tumor necrosis factor α, interleukin (IL)-1β, IL-6, diamine oxidase, endotoxin, albumin, prealbumin, fibronectin, and transferrin were measured at baseline as well as on days 3, 7, 14, 21, 28, and 42 after treatment. At each visit, body composition analysis was performed, and Crohn disease activity index was calculated. Significant improvements in inflammatory parameters (C-reactive protein, tumor necrosis factor α, IL-1β, and IL-6) after 1 week and in intestinal barrier function (diamine oxidase and endotoxin) after 2 weeks were observed. These changes proceeded any significant changes in nutritional parameters (body composition analysis and biological parameters) that occurred after 3 to 4 weeks. This study showed that an early therapeutic effect of EN on active adult CD is attributable to down-regulating systemic and intestinal inflammation rather than nutritional restitution.