APPROPRIATE NUTRITIONAL SUPPORT IN ACUTE AND COMPLICATED CROHNS-DISEASE

Crohn's disease is frequently complicated by protein-calorie malnutrit ion. Four common clinical presentations of Crohn's disease include acu te exacerbations or hares of disease, intestinal obstruction, fistuliz ing disease, and perianal disease. In this review, we examine the role of nutritional support in these clinical scenarios. Nutritional suppo rt is important for maintaining functional status and preventing loss of lean tissue. Determinants of lean-tissue loss include severity of u nderlying injury, baseline nutritional status, and duration of inadequ ate nutrition. One of the clinically useful measures of nutritional st atus is the nutritional risk index (NRI) defined on the basis of the s erum albumin and weight loss. Nutritional support is important in seve rely malnourished patients (NRI < 83). Enteral nutrition is the route of choice, provided there are no contraindications to using the gastro intestinal tract. In acute exacerbations of Crohn's disease, enteral n utrition also has a role in the primary management of disease although it is not as effective as corticosteroids in inducing remission. The mechanisms are poorly understood and the most effective enteral formul ation needs to be determined. Total parenteral nutrition is justified in severely malnourished Crohn's disease patients who are unable to to lerate enteral feeding or in whom enteral feeding is contraindicated, More clinical studies are needed on the assessment of malnutrition in Crohn's disease, the effects of nutritional management on functional s tatus, and the timing of nutritional intervention. (C) Elsevier Scienc e Inc. 1998.