Many patients with the inflammatory bowel diseases, Crohn's disease, or ulcerative colitis have significant protein-calorie malnutrition and micronutrient deficiencies. Factors that contribute to these nutritional deficits include inadequate nutrient intake, malabsorption, excessive nutrient secretion across the diseased gastrointestinal tract, drug-nutrient interactions, and increased nutrient requirements. In this review, the use of enteral and parenteral nutrition support as primary therapy for active Crohn's disease and ulcerative colitis is discussed. Other roles for nutrition support in patients with inflammatory bowel disease, including preoperative nutrition support, nutritional treatment of intestinal fistulas and growth retardation, and home parenteral nutrition for gut failure, are also reviewed.
Get full access to this article
View all access options for this article.
References
1.
Rosenberg IH , Bengoa JM, Sitrin, MDNutritional aspects of inflammatory bowel disease. Annu Rev Nutr1985;5:463-84.
2.
Driscoll RH, Rosenberg IHTotal parenteral nutrition in inflammatory bowel disease. Med Clin North Am1978;62: 185-201.
3.
Mathias JR, Clench MHReview: pathophysiology of diarrhea caused by bacterial overgrowth of the small intestine. Am J Med Sci1985;289:243-8.
4.
Franklin JL, Rosenberg IHImpaired folic acid absorption in inflammatory bowel disease: effects of salicylazosulfapyridine (azulfidine). Gastroenterology1973;64:517-25.
5.
Compston JE, Horton LWL.Oral 25-hydroxyvitamin D3 in treatment of osteomalacia associated with ileal resection and cholestyramine therapy. Gastroenterology1978;74:900-2.
6.
Reid IRPathogenesis and treatment of steroid osteoporosis. Clin Endocrinol1989;30:83-103.
7.
Florent C., L'Hirondel C., Desmazures C., et al. Evaluation of ulcerative colitis and Crohn's disease activity by measurement of alpha-1-antitrypsin intestinal clearance. Gastroenterol Clin Biol1981;5:193-7.
8.
Florent C., L'Hirondel C., Desmazures C., et al. Intestinal clearance of alpha-1-antitrypsin. A sensitive method for the detection of protein-losing enteropathy. Gastroenterology1981;81: 777-80.
9.
Wolman GM, Anderson GH, Marliss EB, et al. Zinc in total parenteral nutrition: requirements and metabolic effects. Gastroenterology1979;76:458-67.
10.
Chan ATH , Fleming CR, O'Fallen WM, et al. Estimated versus measured basal energy requirements in patients with Crohn's disease. Gastroenterology1986 ;91:75-8.
11.
Kushner RF, Schoeller DAResting and total energy expenditure in patients with inflammatory bowel disease . Am J Clin Nutr1991;53:161-5.
12.
O'Morain C.Elemental diets in the treatment of Crohn's disease. Proc Nutr Soc1979;38:403-8.
O'Morain C. , Segal AW, Levi AJElemental diet as primary treatment of acute Crohn's disease: a controlled trial. Br Med J1984;288:1859-62.
15.
Saverymuttu S., Hodgson HJF, Chadwich VSControlled trial comparing prednisolone with an elemental diet plus non-absorbable antibiotics in active Crohn's disease . Gut1985;26: 994-8.
16.
Okada M., Yao T., Yamamoto T.Controlled trial comparing an elemental diet with prednisolone in the treatment of active Crohn's disease. Hepatogastroenterology1990;37:72-80.
17.
Malchow H., Steinhardt HJ, Lorenz-Meyer H., et al. Feasibility and effectiveness of a defined-formula diet regimen in treating active Crohn's disease. Scand J Gastroenterol1990;25:235-44.
18.
Lochs H., Steinhardt HJ, Klaus-Wentz B., et al. Comparison of enteral nutrition and drug treatment in active Crohn's disease. Gastroenterology1991;101:881-8.
19.
O'Morain CADoes nutritional therapy in inflammatory bowel disease have a primary or an adjunctive role? Scan J Gastroenterol1990;25 (suppl 172):29-34.
20.
Axelsson CK , Justessen T.Studies of the duodenal and faecal floral in gastrointestinal disorders during treatment with an elemental diet . Gastroenterology1977;72:397-401.
21.
Logan RFA , Gillon J., Ferrington C., et al. Reduction of gastrointestinal protein loss by elemental diet in Crohn's disease of the small bowel. Gut1981;22:383-7.
22.
Souba WW, Smith RJ, Wilmore DWGlutamine metabolism by the intestinal tract. JPEN1985;9:608-17.
23.
Giaffer MH, North G., Holdsworth CDControlled trial of polymeric versus elemental diet in treatment of active Crohn's disease. Lancet1990;335:816-9.
24.
Klein S.Elemental versus polymeric feeding in patients with Crohn's disease-is there really a winner? Gastroenterology1990 ;99:893-4.
Ostro MJ, Greenberg GR, Jeejeebhoy KNTotal parenteral nutrition and complete bowel rest in the management of Crohn's disease. JPEN1985;9:280-7.
27.
Lerebours E. , Messing B., Chevalier B., et al. An evaluation of total parenteral nutrition in the management of steroid-dependent and steroid-resistant patients with Crohn's disease. JPEN1986;10:274-8.
28.
Muller JM, Keller HW, Erasmi H., et al. Total parenteral nutrition as the sole therapy in Crohn's disease-a prospective study. Br J Surg1983;70:40-3.
29.
Sitzmann JV , Converse RL Jr, Bayless TMFavorable response to parenteral nutrition and medical therapy in Crohn's colitis. Gastroenterology1990;99:1647-52.
30.
Kushner RF, Shapir J., Sitrin MDEndoscopic, radiographic, and clinical response to prolonged bowel rest and home parenteral nutrition in Crohn's disease. JPEN1986;10:568-73.
31.
Greenberg GR , Fleming CR, Jeejeebhoy KN, et al. Controlled trial of bowel rest and nutritional support in the management of Crohn's disease . Gut1988;29:1309-15.
32.
Cravo M., Camilo ME, Correia JPNutritional support in Crohn's disease: which route? Am J Gastroenterol1991;86: 317-21.
33.
Wright RA, Adler ECPeripheral parenteral nutrition is no better than enteral nutrition in acute exacerbation of Crohn's disease: a prospective trial. J Clin Gastroenterol1990;12: 396-9.
34.
Jones A.Comparison of total parenteral nutrition and elemental diet in induction of remission of Crohn's disease. Dig Dis Sci1987;32 (suppl):100s-7s.
35.
Dickinson RJ , Ashton MG, Axon ATR, et al. Controlled trial of intravenous hyperalimentation and total bowel rest as a adjunct to the routine therapy of acute colitis . Gastroenterology1980;79:1199-204.
36.
Detsky AS, Baker JP, O'Rourke K., et al. Perioperative parenteral nutrition: a meta-analysis. Ann Intern Med1987;107: 195-203.
37.
The Veterans Affairs Total Parenteral Nutrition Cooperative Study Group.Perioperative total parenteral nutrition in surgical patients. N Engl J Med1991;325:525-32.
38.
Rombeau JL, Barot LR, Williamson CE, et al. Preoperative total parenteral nutrition and surgical outcome in patients with inflammatory bowel disease. Am J Surg1982;143:139-43.
39.
Soeters PB, Von Meyenfeldt MF, Gouma DJNutritional factors in timing and preparation of operation for Crohn's disease . Scand J Gastroenterol1988;2361-5.
40.
Christie PM , Hill GLEffect of intravenous nutrition on nutrition and function in acute attacks of inflammatory bowel disease. Gastroenterology1990;99:730-6.
41.
Lashner BA, Evans AA, Hanauer SBPreoperative total parenteral nutrition for bowel resection in Crohn's disease . Dig Dis Sci1989;34:741-6.
42.
Blair GK, Yaman M., Wesson DEPreoperative home elemental enteral nutrition in complicated Crohn's disease . J Pediatr Surg1986;21:769-71.
43.
Hawker PC, Givel JC, Keighley MRB, et al. Management of enterocutaneous fistulae in Crohn's disease. Gut1983;284-7.
44.
McIntyre PB , Ritchie JK, Hawley PR, et al. Management of enterocutaneous fistulas: a review of 132 cases. Br J Surg1984; 71:293-6.
45.
Soeters PBGastro-intestinal fistulas: the role of nutritional support. Acta Chir Belg1985;85:155-62.
46.
Rombeau JL, Rolandelli RHEnteral and parenteral nutrition in patients with enteric fistulas and short bowel syndrome. Surg Clin North Am1987;67:551-71.
47.
Voitk AJ, Echave V., Brown RA, et al. Elemental diet in the treatment of fistulas of the alimentary tract. Surg Gynecol Obstet1973;137:68-72.
48.
Deitel M.Elemental diet and enterocutaneous fistula. World J Surg1983;7:451-4.
49.
Calam J., Crooks PE, Walker RJElemental diets in the management of Crohn's perianal fistulae. JPEN1980;4:4-8.
Kirschner BS , Klich JR, Kalman SS, et al. Reversal of growth retardation in Crohn's disease with therapy emphasizing oral nutrition restitution. Gastroenterology1981;80:10-5.
52.
Morin CL, Roulet M., Roy C., et al. Continuous elemental enteral alimentation in children with Crohn's disease and growth failure. Gastroenterology1980;79:1205-10.
53.
Belli DC, Seidman E., Bouthillier L., et al. Chronic intermittent elemental diet improves growth failure in children with Crohn's disease. Gastroenterology1988;94:603-10.
54.
Fleming RC, Beart RW Jr, Berkner S., et al. Home parenteral nutrition for management of the severely malnourished adult patient. Gastroenterology1980;79:11-8.
55.
Stokes MA, Almond DJ, Pettit SH, et al. Home parenteral nutrition: a review of 100 patient years of treatment in 76 consecutive cases. Br J Surg1988;75:481-3.
56.
Galandiuk S. , O'Neill M., McDonald P., et al. A century of home parenteral nutrition for Crohn's disease. Am J Surg1990;159: 540-5.
