New insights in nutritional therapy in inflammatory bowel disease

Although meta-analyses have raised serious doubts about the primary therape utic role of enteral nutrition in Crohn's disease, detailed study of these meta-analyses indicates that, as a whole, enteral nutrition is therapeutica lly effective in 60% of patients with active Crohn's disease. This figure i s three times higher than that reported with placebo and as high as that ob tained by various drugs used as alternative therapies to glucocorticoids. M oreover, analysis of the different types of enteral formulas used in the pu blished trials strongly suggest that some of them would be particularly eff ective in this condition. The amount and quality of the lipid component of these formulas seems to be of utmost importance in inducing clinical remiss ion in these patients. Furthermore, nutrition and nutritional deficits are increasingly incriminated in the pathogenesis of Crohn's disease and ulcera tive colitis. In this sense, the potential role of some nutritional deficit s (e.g. micronutrients) or defective nutrient metabolism (decreased butyrat e utilization in the bowel) are discussed. Although studies aimed at identi fying the nutrient (s) responsible for the therapeutic effect of enteral di ets in Crohn's disease are still required, it is time to consider seriously the use of nutritional approaches as steroid sparing treatment in these pa tients. (C) 2001 Harcourt Publishers Ltd.