Undernutrition with
weight loss,
protein deficiency and specific deficiencies in
vitamins, and
trace elements are common in the acute phase of IBD.
Anorexia, increased intestinal losses and systemic
inflammation are the main causes of
undernutrition. The relevance and extent of these deficiencies vary according to the site and extent of diseased intestine as well as disease activity. Mechanisms of EN efficacy as a primary treatment of IBD are not revealed yet. However, most physicians start to be earnest about
enteral feeding because this treatment method does not cause any serious or prolonged complications. There are no significant differences in the effect of free
amino acid,
peptide-based and whole
protein formulae for EN in IBD.
Nutritional support with normal food is considered the treatment of choice. This article gives recommendations for the indication, application and type of formula of EN (oral nutritional supplements (ONS) or
tube feeding (TF)) in patients with IBD. These are based on all relevant publications since 1995 and own authors experience. ONS and/or TF in addition to normal food is indicated in undernourished patients with IBD to improve nutritional status and quality of life. In active IBD EN should be used as sole
therapy in adults mainly when treatment with
corticosteroids is not feasible, e.g. due to intolerance or refusal. Combined
therapy (EN and drugs) is indicated in undernourished patients as well as in those with inflammatory
stenosis of the intestine. With ONS, a supplementary intake of up to 600 kcal/day can be achieved in addition to normal food. If a higher intake is required, TF is necessary. TF can be safely delivered by the nasogastric tube (NGT). Continuous administration of TF rather than bolus delivery is preferred because of the lower complication. In remission of IBD ONS and/or TF are recommended.