Impacts of long-term enteral nutrition on clinical and endoscopic disease activities and mucosal cytokines during remission in patients with Crohn's disease: A prospective study

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Original Article

Impacts of long-term enteral nutrition on clinical and endoscopic disease activities and mucosal cytokines during remission in patients with Crohn's disease: A prospective study

Takayuki Yamamoto, MD, FACG 1 *, Maki Nakahigashi, RD 1, Abbi R. Saniabadi, PhD 2, Takashi Iwata, MD 1, Yasuki Maruyama, MD 1, Satoru Umegae, MD 1, Koichi Matsumoto, MD 1

1Inflammatory Bowel Disease Center, Yokkaichi Social Insurance Hospital, Yokkaichi, Mie, Japan2Department of Pharmacology, Hamamatsu University, Japan

email: Takayuki Yamamoto (nao-taka@...)

*Correspondence to Takayuki Yamamoto, Inflammatory Bowel Disease Center, Yokkaichi Social Insurance Hospital, 10-8 Hazuyamacho, Yokkaichi, Mie 510-0016, Japan

Keywords

Crohn's disease • cytokine • elemental diet • endoscopic inflammation • enteral nutrition • mucosa • relapse

Abstract

Background: Long-term enteral nutrition may maintain clinical and endoscopic remission in patients with Crohn's disease (CD). The aim of this prospective study was to investigate the impacts of long-term enteral nutrition on clinical and endoscopic disease activities and mucosal tissue cytokines in patients with quiescent CD.

Methods: Forty patients with CD who achieved clinical remission were included. Of these, 20 received continuous elemental diet (Elental) infusion during the nighttime and a low-fat diet during the daytime (EN group) and 20 received neither nutritional therapy nor food restriction (non-EN group). With these regimens, all 40 patients were monitored for 1 year. Further, ileocolonoscopy was performed at entry, at 6 and 12 months, and mucosal biopsies were taken for cytokine assays.

Results: On an intention-to-treat basis, 5 patients (25%) in the EN group and 13 (65%) in the non-EN group had a clinical relapse during the 1-year observation (P = 0.03). The mean endoscopic inflammation (EI) scores were not significantly different between the groups at both entry and 6 months, but at 12 months EI scores were significantly higher in the non-EN group than in the EN group (P = 0.04). Additionally, the mucosal tissue interleukin (IL)-1, IL-6, and tumor necrosis factor (TNF)- levels significantly increased with time in the non-EN group (entry versus 12 months, IL-1, P = 0.02; IL-6, P = 0.002; TNF-, P = 0.001). In the EN group these cytokines did not show a significant increase.

Conclusions: Long-term enteral nutrition in patients with quiescent CD has a clear suppressive effect on clinical and endoscopic disease activities and the mucosal inflammatory cytokine levels.

(Inflamm Bowel Dis 2007)

Received: 1 February 2007; Accepted: 27 June 2007

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