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. 2019 Sep 10;4(2):260-266.
doi: 10.1002/jgh3.12256. eCollection 2020 Apr.

Exclusive enteral nutrition: An optimal care pathway for use in adult patients with active Crohn's disease

Alice Day  1 , Jessica Wood  2 , Sarah Melton  2 , Robert V Bryant  1
Affiliations

Exclusive enteral nutrition: An optimal care pathway for use in adult patients with active Crohn's disease

Alice Day et al. JGH Open. .

Abstract

Background and aim: Exclusive enteral nutrition (EEN) is progressively being used as a therapeutic option for adults with Crohn's Disease (CD); however, there is no standardized approach to delivering this therapy. The aim of this study is to develop an optimal care pathway for using EEN in adults with CD. This will create a standard of care that can be used as a benchmark practice and will provide direction for future research.

Methods: A working group of 12 multidisciplinary inflammatory bowel disease specialists across Australia and New Zealand was convened to develop a practical, clinically focused care pathway for using EEN in adults with active CD. Six key areas were identified as part of the care pathway: clinical indications, nutrition assessment, EEN protocol, monitoring, accessing formula, and food reintroduction. Current literature was identified via systematic review, and quality of evidence was graded. Consensus expert opinion was used where literature gaps were identified.

Results: An optimal care pathway for using EEN in adults with CD was developed with six key consensus statements on how to use EEN in adults with active CD. These key statements identify clinical indications for use, nutrition assessment, enteral prescription and duration of therapy, monitoring criteria, food reintroduction, and the role of partial EEN. An accompanying patient resource was also developed.

Conclusion: EEN is recommended as a treatment option to induce remission in adults with active CD. The consensus statements developed are practical and are based on best available evidence and expert opinion to assist in developing a standardized approach to delivering EEN therapy.

Keywords: Crohn's disease; diet; exclusive enteral nutrition; nutrition.

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Figures

Figure 1
Figure 1
Optimal care pathway for using exclusive enteral nutrition in adults with active CD. CD, Crohn's disease; Clin Ax, clinical assessment; CRP, C‐reactive protein; E/P, energy/protein; EEN, exclusive enteral nutrition; FC, fecal calprotectin; MDT, multidisciplinary team; NGT, nasogastric tube; Nut Ax, nutritional assessment.
Figure 2
Figure 2
Weaning exclusive enteral nutrition formula and reintroducing food.
See this image and copyright information in PMC

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