When discussing general nutritional therapy, there are two primary forms used in medical practice, enteral and parenteral nutrition. Enteral nutrition, often referred to as tube feeding, allows for feeding into the GIT through a tube inserted nasally and fed into the stomach or small intestine. For long term usage, tubes can be surgically inserted into the stomach or small intestine through an opening made in the abdomen. Parenteral nutrition is the practice of feeding a person intravenously, and it completely bypasses the use of the stomach or intestines.
In terms of Crohn's disease, enteral nutrition is more often used as primary nutritional therapy. Parenteral nutrition is used in special cases or those of a higher severity. The overall goal for the use of diet therapy in Crohns is to correct any nutritional disturbances present and to help control the inflammatory response occurring. Remission rates of patients placed on enteral nutrition range from 53% to 80%; therefore, a direct anti-inflammatory effect of enteral nutrition in Crohn's disease is generally accepted. In one particular study, a decrease in the level of proinflammatory cytokines IL-1, IL-8, and IFN-gamma was observed in patients being treated through enteral nutrition. However, the direct mechanism of action for these observed anti-inflammatory effects is still not known.
Two mechanisms are currently proposed for the therapeutic efficacy of enteral nutrition in Crohns. The first mechanism is that the bowel rest allowed by the enteral feeding results in alteration of the intestinal flora and elimination/reduction of antigens. The second mechanism is that improvement in nutritional status by increase in nutrient intake and absorption aids in the induction of remission and reduction in intestinal protein loss.
Enteral nutrition usually has low compliance among adult Crohn's disease patients. Many find tube-feeding to be inconvenient, and a higher percentage of patients are more responsive to other medical treatments. Often enteral nutrition is seen as an effective adjuvant treatment in many cases. Enteral nutrition is far more widely used in the treatment of children with Crohns, and is often necessary to ensure proper nutrition and growth status.
Parenteral nutrition is used in cases of more severe disease when total bowel rest is a recommendation. It is also used in cases where patients have a poor tolerance to enteral nutrition; however, it is never recommended as a sole therapy in Crohn's disease.
Reference:
Moorthy D. Cappellano KL. Rosenberg IH. Nutrition and Crohn's disease: an update of print and web-based guidance. Nutrition Reviews. 2008; 66(7): 387-397.
Subscribe to:
Post Comments (Atom)
1 comment:
I also looked at that article while trying to find information about diets for people with IBD. I also came across an article by Dawn M. Wiese titled "Is There a Role for Bowel Rest in Nutrition Management of Crohn's Disease?" It is a rather interesting article and she discusses a paper written by GR Greenburg. If you are interested in nurtition I suggest you check it out.
Post a Comment