PRACTICAL ASPECTS OF ENTERAL NUTRITION IN THE MANAGEMENT OF CROHNS-DISEASE

Background: Enteral nutrition regimens achieve remission from active C rohn's disease at rates comparable to steroids and total parenteral nu trition. Despite their increasing use there has to date been no assess ment of patient tolerance or practical difficulties involved. Methods: We investigated 147 treatments with elemental diet in 89 patients and followed this with an anonymous questionnaire. Results: Sip feeding w as successfully introduced in 85% with nasogastric feeding being neces sary in 22 (15%). Nausea and postural hypotension were common in the f irst week of treatment but vomiting was only seen in three patients wh o were sensitive to the formula used. Two patients each had caffeine w ithdrawal symptoms and hypoglycemia and a further four had food-relate d night terrors. Our experience suggests that caution is necessary if this treatment is used in elderly subjects. Although the diets are per ceived as being unpalatable, only six patients found taste to be a pro blem after the first week of treatment. The main problem with long-ter m treatment was the large daily volume requirement, which was overcome by increasing the concentration of the feed. Eighty percent of patien ts responded to the questionnaire, and 65% stated that they would opt for treatment with elemental diet again in the case of a further relap se. Conclusions: Elemental diet seems to be an acceptable and well-tol erated form of treatment in Crohn's disease.