Efficacy of exclusive enteral nutrition in complicated Crohn's disease
Efficacy of exclusive enteral nutrition in complicated Crohn's disease
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单纯肠内营养治疗复杂性克罗恩病的疗效
DOI：
10.1080/00365521.2017.1335770
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发表时间：
2017-01-01
影响因子：
1.9
通讯作者：
Hu, Pinjin
中科院分区：
文献类型：
--
作者：
Yang, Qingfan;Gao, Xiang;Hu, Pinjin
目的：目的探讨单纯肠内营养（EEN）对成人活动性克罗恩病（CD）并发肠瘘/腹腔脓肿或炎性肠狭窄的诱导缓解效果。患者接受EEN治疗12周。脓肿患者接受抗生素治疗，或不经皮引流。记录临床变量（ClinicalTrials.gov标识符：NCT 02887287）。结果：纳入41例CD患者，年龄18-60岁，伴有肠瘘/腹腔脓肿或炎性肠狭窄。10例伴有狭窄，33例伴有肠瘘/脓肿。EEN治疗12周后，克罗恩病活动指数显著降低（223.4365.5 vs. 106.77 +/- 42.73，p.001），80.5%的患者完全达到临床缓解。在75%的肠外瘘患者中观察到EEN后瘘口闭合。在狭窄的患者中，20%对EEN无反应，并被转移到手术。EEN治疗12周后，分别有20%和60%的患者部分缓解和完全缓解。76%的患者腹腔内脓肿消退。17例粘膜溃疡患者在EEN前后均行结肠镜检查，47%的患者治疗后粘膜愈合。结论：EEN治疗成人CD并发症可使CD早期临床缓解、黏膜愈合、促进瘘管闭合、缩小脓肿面积。
Aim: To investigate the efficacy of exclusive enteral nutrition (EEN) in induction of remission in adult active Crohn's disease (CD) complicated with intestinal fistula/abdominal abscess or inflammatory intestinal stricture.Method: Patients diagnosed with active CD with complications were recruited between July 2013 and July 2015. Patients were offered EEN for 12 weeks. Patients with abscess received antibiotic treatment with or without percutaneous drainage. Clinical variables were recorded (ClinicalTrials.gov Identifier: NCT02887287).Results: Forty-one patients with CD and with intestinal fistula/abdominal abscess or inflammatory intestinal stricture aged 18-60 years, were included. Ten patients were accompanied with stenosis and 33 with intestinal fistula/abscess. After 12 weeks of EEN, the Crohn's disease activity index significantly decreased (223.4365.5 vs. 106.77 +/- 42.73, p.001), and 80.5% of patients achieved full clinical remission totally. Fistula closure after EEN was observed in 75% of patients with entero-cutaneous fistula. In patients with stenosis, 20% had no response to EEN and were transferred for surgery. Partial remission and full remission were observed in 20% and 60% of patients after 12 weeks of EEN, respectively. Intra-abdominal abscess resolved in 76% of patients. Seventeen patients who had mucosal ulcers underwent colonoscopy before and after EEN, 47% achieved mucosal healing after the treatment. The inflammatory index of patients significantly decreased (p.01), nutritional parameters increased (p.01) and the European Nutritional Risk Screening (2002) decreased (p.01).Conclusion: EEN is effective in inducing early clinical remission, mucosal healing, promoting fistula closure and reducing the size of abscess in adult CD patients with complications.