Preoperative Nutritional Conditioning of Crohn's Patients-Systematic Review of Current Evidence and Practice

Abstract

Crohn's disease is an incurable and frequently progressive entity with major impact on affected patients. Up to half of patients require surgery in the first 10 years after diagnosis and over 75% of operated patients require at least one further surgery within lifetime. In order to minimize surgical risk, modifiable risk factors such as nutritional status need to be optimized. This systematic review on preoperative nutritional support in adult Crohn's patients between 1997 and 2017 aimed to provide an overview on target populations, screening modalities, routes of administration, and expected benefits. Pertinent study characteristics (prospective vs. retrospective, sample size, control group, limitations) were defined a priori. Twenty-nine studies were retained, of which 14 original studies (9 retrospective, 4 prospective, and 1 randomized controlled trial) and 15 reviews. Study heterogeneity was high regarding nutritional regimens and outcome, and meta-analysis could not be performed. Most studies were conducted without matched control group and thus provide modest level of evidence. Consistently, malnutrition was found to be a major risk factor for postoperative complications, and both enteral and parenteral routes were efficient in decreasing postoperative morbidity. Current guidelines for nutrition in general surgery apply also to Crohn's patients. The route of administration should be chosen according to disease presentation and patients' condition. Further studies are needed to strengthen the evidence.

Keywords: Crohn’s; complications; inflammatory bowel disease; nutrition; preoperative; supplement; surgery.

Figure 1

The selection process adhere to the guidelines outlined in the PRISMA statement [18].

Figure 2

Nutritional treatment algorithm for preoperative nutritional screening and perioperative nutrition in digestive surgery in Crohn’s patients. Abbreviations: NRS—Nutritional Risk Score, MUST—Malnutrition Universal Screening Tool; EEN—exclusive enteral nutrition; PN—parenteral nutrition; EN—enteral nutrition; TPN—total parenteral nutrition; preop—preoperative; postop—postoperative.