Frequent Dietetic Involvement Enhances Adherence and Clinical Outcomes of Exclusive Enteral Nutrition in Adults With Crohn's Disease

Background and Aim:

Use of Exclusive Enteral Nutrition (EEN) in adults has been limited by lack of defined protocols, pooradherence and perceived lack of efficacy. This study evaluated EEN therapy in adults with Crohn's disease (CD) to identify determinants of clinical efficacy, adherence, and therapy completion.

Methods:

This retrospective, multicenter study included consecutive adults (≥18 years old) prescribed EEN for CD betweenFebruary 1, 2019, and February 28, 2022, at two tertiary teaching hospitals. The primary outcome was clinical remission (HarveyBradshaw Index (HBI) ≤4) or response (HBI reduction ≥3). Therapy completion and adherence were measured. Intention-totreat and per-protocol analyses were performed.

Results:

One-hundred-and-eight patients were included; 54 (50.0%) were female. Mean age was 41.8±16.1 years. Ileocolonicdisease was present in 47.2% (51/108), and 40.7% (44/108) had stricturing phenotype. Baseline HBI was 8 (IQR 6–11); 60.2%(65/108) received advanced therapies. Among 80 patients treated for remission induction, remission and response rates were50.0% (40/80) and 48.8% (39/80), respectively. Completion rate was 69.4% (75/108). Complete diet adherence was observed in67.6% (73/108). On multivariable analysis, frequency of dietetic review was associated with therapy completion (odds ratio (OR)2.26, 95% confidence interval (CI) 1.51–3.39, p<0.001). Active smoking (OR 0.11, 95% CI 0.02–0.83, p=0.032) reduced odds ofremission, whereas early remission (OR 17.56, 95% CI 3.18–96.84, p=0.001) and early response (OR 4.94, 95% CI 1.09–22.43,p=0.039) were predictors of clinical remission at end-of-therapy.

Conclusions:

Early assessment and frequent dietetic follow-up improve EEN adherence, completion, and outcomes in adults