Nutritional interventions in adult fibrostenotic Crohn's disease: A systematic review

Jared L Cooper; Ryan E Rosentreter; Alexis Filyk; Zahra A Premji; Hua Shen; Richard Ingram; Gilaad G Kaplan; Christopher Ma; Kerri Novak; Remo Panaccione; Cynthia H Seow; Florian Rieder; Maitreyi Raman; Cathy Lu

doi:10.3389/fnut.2023.1017382

Nutritional interventions in adult fibrostenotic Crohn's disease: A systematic review

Front Nutr. 2023 Feb 21:10:1017382. doi: 10.3389/fnut.2023.1017382. eCollection 2023.

Authors

Jared L Cooper¹, Ryan E Rosentreter², Alexis Filyk², Zahra A Premji³, Hua Shen⁴, Richard Ingram², Gilaad G Kaplan^{2

5}, Christopher Ma^{2

5}, Kerri Novak², Remo Panaccione², Cynthia H Seow^{2

5}, Florian Rieder^{6

7}, Maitreyi Raman^{2

5}, Cathy Lu²

Affiliations

¹ Department of Medicine, University of Calgary, Calgary, AB, Canada.
² Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, AB, Canada.
³ Libraries, University of Victoria, Victoria, BC, Canada.
⁴ Department of Mathematics and Statistics, University of Calgary, Calgary, AB, Canada.
⁵ Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
⁶ Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, United States.
⁷ Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, United States.

Abstract

Background: Management of Crohn's disease (CD) using dietary interventions has become an area of increased research interest. There is a lack of specific research exploring if diet and nutrition interventions are beneficial in patients with strictures, as current dietary recommendations in fibrostenotic CD are often based on clinical judgment. The aim of this systematic review was to assess the impact of dietary interventions in fibrostenotic CD on medical and surgical outcomes.

Methods: A systematic search of MEDLINE (Ovid), EMBASE (Ovid), CINAHL (EBSCO), and Cochrane Central Register of Controlled Trials (Ovid) was conducted. Studies reporting dietary interventions or nutritional factors in fibrostenotic CD were included. Outcomes for studies assessing dietary interventions such as enteral nutrition were evaluated as changes in (1) CD symptoms (CD Activity Index), (2) stricture parameters on diagnostic imaging, and (3) rates of surgical or medical intervention following dietary interventions.

Results: Five studies were included in this review. Three studies assessed exclusive enteral nutrition (EEN), one evaluated total parenteral nutrition (TPN), and one studied a liquid diet. All included studies evaluated symptoms as an outcome, while diagnostic imaging parameters and surgical outcomes in the studies were either absent or too heterogeneous to appraise improvement post dietary intervention. Included EEN studies displayed similar efficacy, with approximately 60% of patients having symptom improvement. The included TPN study also reported 75% of patients with symptom improvement, while the liquid diet did not.

Conclusion: Exclusive enteral nutrition and total parental nutrition may provide benefit for use as a dietary intervention for fibrostenotic CD. There remains a need for high-quality controlled trials which utilize standardized definitions of strictures.

Keywords: Crohn’s disease; diet; fibrostenosis; nutrition; stricture.

Publication types

Systematic Review

Abstract

Publication types

Grants and funding