EFFICACY OF NUTRITIONAL THERAPY FOR ACTIVE CROHNS-DISEASE

We investigated the effect of nutritional therapy with an elemental di et (ED) for active Crohn's disease. One hundred and thirty-nine patien ts with Crohn's disease were enrolled in this study. Remission was jud ged to be present when the International Organization of Inflammatory Bowel Disease score was less than or equal to 1 and the CRP and ESR va lues were within the respective normal ranges. An amount of 30 kcal pe r 1 kg of ideal body weight (IBW) per day was administered enterally, and the effect on the induction of remission in relation to various pa tient background factors, such as disease type, history of bowel resec tion, and the presence/absence of complications, was determined. An ex cellent remission rate was achieved in those patients to whom an adequ ate amount of ED could be administered. Remission rates were lower in the patient groups with any of the following complications: stenotic b owel lesions, abdominal masses, fistulas, and anal lesions. Even in th ose groups in which stenotic lesions or abdominal masses were present, when adequate amounts of ED could be administered, the remission rate did not differ from that in the groups without these complications. T he remission rates in the groups with and without fistulas at any site , including fistulas in the anal region, were 40.0% and 82.5%, respect ively, with remission being considerably easier to achieve in the pati ents without fistulas. Similarly, remission was difficult to achieve w hen anal lesions were present. These results suggest that, for active Crohn's disease, nutritional therapy with ED (greater than or equal to 35 kcal/kg LBW) should be enthusiastically administered, and in patie nts in whom the presence of complications necessitates therapy for 3 m onths or more, this point be considered to indicate a possible surgica l approach.