Practical Aspects of Enteral Nutrition in the Management of Crohn's Disease

Background: Enteral nutrition regimens achieve remission from active Crohn's disease at rates comparable to steroids and total parenteral nutrition. Despite their increasing use there has to date been no assessment of patient tolerance or practical difficulties involved. Methods: We investigated 147 treatments with elemental diet in 89 patients and followed this with an anonymous questionnaire. Results: Sip feeding was successfully introduced in 85% with nasogastric feeding being necessary in 22 (15%). Nausea and postural hypotension were common in the first week of treatment but vomiting was only seen in three patients who were sensitive to the formula used. Two patients each had caffeine withdrawal symptoms and hypoglycemia and a further four had food-related night terrors. Our experience suggests that caution is necessary if this treatment is used in elderly subjects. Although the diets are perceived as being unpalatable, only six patients found taste to be a problem after the first week of treatment. ...