Nutritional Management of Inflammatory Bowel Disease: Exclusive Enteral Nutrition Beyond Paediatrics
DOI:
https://doi.org/10.5281/zenodo.22281734Keywords:
Crohn's disease, Exclusive enteral nutrition, Corticosteroids, Adherence, Evidence qualityAbstract
Exclusive enteral nutrition is first-line induction therapy for paediatric Crohn's disease and is not offered as sole primary therapy
to most adults. The pooled evidence explains why, and also complicates the explanation. Across eight trials in 223 participants,
remission on enteral nutrition was 50 per cent against 72 per cent on corticosteroids, a risk ratio of 0.77 (95% CI 0.58 to 1.03)
with substantial heterogeneity. Splitting by age reverses the direction: adults 45 against 73 per cent, giving 0.65 (0.52 to 0.82),
and children 83 against 61 per cent, giving 1.35 (0.92 to 1.97). The complication is what happens when withdrawals for tube
intolerance and unpalatable formula are removed. On per-protocol analysis the adult deficit narrows to 0.82 (0.70 to 0.95) and
the paediatric advantage becomes significant at 1.43 (1.03 to 1.97). Adults were nearly three times more likely to withdraw for
adverse events, at 2.95 (1.02 to 8.48), while adverse events themselves did not differ. The adult result is therefore consistent with a
tolerability problem rather than a different biology, and no trial has separated the two. Every estimate in the review is rated very
low quality.
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