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Exclusive enteral nutrition versus corticosteroids for treatment of pediatric Crohn's disease: a meta-analysis

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World Journal of Pediatrics 2019年第1期15卷 26-36页

作者： Yu Yu Kang-Chen Chen Jie Chen Department of Gastroenterology Children's HospitalZhejiang University School of Medicine3333 Binsheng RoadBinjiang DistrictHangzhou 310051China First Affiliated Hospital Zhejiang University School of Medicine79 Qingchun RoadShangcheng DistrictHangzhou 310002China

Background Many studies have examined the effects of exclusive enteral nutrition (EEN) in children with Crohn's disease (CD),but corticosteroids are considered a superior therapy and are frequently used in *** meta-analysis aims to compare the efficacy of EEN with corticosteroids in treating pediatric *** A comprehensive retrieval from medical databases,including PubMed,EMBASE,MEDLINE,Web of Science,Wanfang data,VIP and CNKI,was performed using the search terms 'diet therapy','exclusive enteral nutrition','Crohn's disease','inflammatory bowel diseases','child' and 'pediatrics' from January 1990 to April *** We included 18 studies from 1329 identified sources in this *** was as effective as corticosteroids in inducing remission rate of children suffering from CD (OR =1.35;95% CI 0.90,2.10;P =0.14).Nevertheless,patients who received EEN were more likely to achieve both endoscopic mucosal healing (OR =5.24;95% CI 2.06,13.37;P =0.0005)and histological mucosal healing (OR =4.78;95% CI 1.89,12.08;P=0.0009) than those who received corticosteroids;the Pediatric Crohn's Disease Activity Index was lower [mean difference (MD)=-3.67;95% CI-4.91,-2.43] and weight gain was higher (MD=1.92;95% CI 0.02,3.83;P=0.05) in those patients who received EEN than in those who received *** difference was found in relapse rate (OR =0.57;95% CI 0.25,1.29;P=0.18),height for age or body mass index between the patients treated with EEN and corticosteroids at the 1-year end *** This meta-analysis reveals that there is no significant difference between EEN and corticosteroids in the efficacy of inducing remission rate of CD in a pediatric population,but EEN is superior to corticosteroids in improving short-term mucosal inflammation and reducing the PCDAI index.

关键词： Children Corticosteroids Crohn's disease Exclusive enteral nutrition Inflammatory bowel disease Nutrition

Protective effect of early enteral feeding on postburn impairment of liver function and its mechanism in rats

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World Journal of Gastroenterology 2000年第1期6卷 79-83页

作者： Zhu L Yang ZC Li A Cheng DC Institute of Burn Research Southwest HospitalThird Military Medical UniversityChongqing 400038China Critical Care Department Peking Union Medical College Hospital(PUMCH)Chinese Academy of Medical science(CAMS)Beijing 100730China

AIM To study the protective effect of earlyenteral feeding(EEF)on the postburnimpairment of liver function and its *** Wistar rats with 30% of total bodysurface area(TBSA)full-thickness burn *** effects of EEF on the postburnchanges of gastric intramucosal pH,endotoxinlevels in portal vein,water contents of hepatictissue,blood concentrations of tumor necrosisfactor(TNF-α),plasma activities of alanineaminotransferase(ALT)and asparateaminotransferase(AST),as well as the bloodcontents of total(TB)and direct bilirubin(DB),total protein(TP)and albumin(ALB)wereserially determined within 48h *** EEF could significantly improvegastric mucosal acidosis,reduce portal veinendotoxin level and water content of hepatictissue,as well as plasma concentrations of TNF-α at all timepoints after severe burns(P<0.01);postburn elevation of the plasma activities ofALT,AST and the contents of TB,DB wereeffectively prevented,whereas the plasmaconcentrations of TP and ALB were markedlyincreased 24 h and 48 h posturn in EEF groupcompared with that of the burn without EEFgroup(P<0.01).CONCLUSION EEF has significant beneficialeffects on the improvement of hepatic function in rats after severe burn,and is probably relatedwith an increase in splanchnic blood flow,reduction of the absorption of gut-originendotoxin and the consequent release ofinflammatory mediators.

关键词： Subject headings early enteral feeding liver postburn impairments

Effects of early enteral nutrition on Th17/Treg cells and IL-23/IL-17 in septic patients

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World Journal of Gastroenterology 2019年第22期25卷 2799-2808页

作者： Jia-Kui Sun Wen-Hao Zhang Wen-Xiu Chen Xiang Wang Xin-Wei Mu Department of Intensive Care Unit Nanjing First Hospital Nanjing Medical University

BACKGROUND The imbalance of Th17/Treg cells and the IL-23/IL-17 axis have been confirmed to be associated with sepsis and various inflammatory diseases. Early enteral nutrition (EEN) can modulate the inflammatory response, improve immune dysfunction, and prevent enterogenic infection in critically ill patients;however, the precise mechanisms remain unclear. Considering the important roles of Th17 and Treg lymphocytes in the development of inflammatory and infectious diseases, we hypothesized that EEN could improve the immune dysfunction in sepsis by maintaining a balanced Th17/Treg cell ratio and by regulating the IL- 23/IL-17 axis. AIM To investigate the effects of EEN on the Th17/Treg cell ratios and the IL-23/IL-17 axis in septic patients. METHODS In this prospective clinical trial, patients were randomly divided into an EEN or delayed enteral nutrition (DEN) group. enteral feeding was started within 48 h in the EEN group, whereas enteral feeding was started on the 4th day in the DEN group. The Th17 and Treg cell percentages and the interleukin levels were tested on days 1, 3, and 7 after admission. The clinical severity and outcome variables were also recorded. RESULTS Fifty-three patients were enrolled in this trial from October 2017 to June 2018. The Th17 cell percentages, Th17/Treg cell ratios, IL-17, IL-23, and IL-6 levels of the EEN group were lower than those of the DEN group on the 7th day after admission (P < 0.05). The duration of mechanical ventilation and of the intensive care unit stay of the EEN group were shorter than those of the DEN group (P <0.05). However, no difference in the 28-d mortality was found between the two groups (P = 0.728). CONCLUSION EEN could regulate the imbalance of Th17/Treg cell ratios and suppress the IL- 23/IL-17 axis during sepsis. Moreover, EEN could reduce the clinical severity of sepsis but did not reduce the 28-d mortality of septic patients.

关键词： Early enteral nutrition enteral nutrition T helper lymphocytes Th17/Treg cells IL-23/IL-17 axis Sepsis

Use of exclusive enteral nutrition in adults with Crohn's disease: A review

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World Journal of Gastroenterology 2013年第43期19卷 7652-7660页

作者： Catherine L Wall Andrew S Day Richard B Gearry Department of Paediatrics University of OtagoChristchurch 8140New Zealand Department of Medicine University of OtagoChristchurch 8140New Zealand

Exclusive enteral nutrition(EEN)is well-established as a first line therapy instead of corticosteroid(CS)therapy to treat active Crohn’s disease(CD)in *** also has been shown to have benefits over and above induction of disease remission in paediatric ***,other than in Japanese populations,this intervention is not routinely utilised in *** investigate potential reasons for variation in response between adult studies of EEN and CS *** Ovid database was searched over a 6-mo *** directly comparing EEN and CS therapy in adults were *** articles were *** therapy remission rates varied *** compliance with EEN therapy due to unpalatable formula was an issue in half of the *** rates of studies that only included patients with previously untreated/new CD were higher than studies including patients with both existing and new *** was limited evidence to determine if disease location,duration of disease or age of diagnosis affected EEN therapy *** is some evidence to support the use of EEN as a treatment option for a select group of adults,namely those motivated to adhere to an EEN regimen and possibly those newly diagnosed with *** addition,the use of more palatable formulas could improve treatment compliance.

关键词： Exclusive enteral nutrition Crohn’s disease Adults

Impact of enteral nutrition on energy metabolism in patients with Crohn's disease

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World Journal of Gastroenterology 2015年第4期21卷 1299-1304页

作者： Jie Zhao Jian-Ning Dong Jian-Feng Gong Hong-Gang Wang Yi Li Liang Zhang Lu-Gen Zuo Yun Feng Li-Li Gu Ning Li Jie-Shou Li Wei-Ming Zhu Department of General Surgery Jinling HospitalMedical School of Nanjing University

AIM: To investigate the impact of enteral nutrition(EN) on the body composition and metabolism in patientswith Crohn's disease(CD). METHODS: Sixty-one patients diagnosed with CD were enrolled in this study. They were given only EN(enteral nutritional suspension, TPF, non-elemental diet) support for 4 wk, without any treatment with corticosteroids, immunosuppressive drugs, infliximab or by surgical operation. Body composition statistics such as weight, body mass index, skeletal muscle mass(SMM), fat mass, protein mass and inflammation indexes such as C-reactive protein(CRP), erythrocyte sedimentation rate(ESR) and CD activity index(CDAI) were recorded before and after EN support. RESULTS: The 61 patients were divided into three groups according to CDAI before and after EN support: A(active phase into remission via EN, n = 21), B(remained in active phase before and after EN, n = 19) and C(in remission before and after EN, n = 21). Patients in group A had a significant increase in SMM(22.11 ± 4.77 kg vs 23.23 ± 4.49 kg, P = 0.044), protein mass(8.01 ± 1.57 kg vs 8.44 ± 1.45 kg, P = 0.019) and decrease in resting energy expenditure(REE) per kilogram(27.42 ± 5.01 kcal/kg per day vs 22.62 ± 5.45 kcal/kg per day, P < 0.05). There was no significant difference between predicted and measured REE in active CD patients according to the HarrisBenedict equation. There was no linear correlation between the measured REE and CRP, ESR or CDAI in active CD patients. CONCLUSION: EN could decrease the hypermetabolism in active CD patients by reducing the inflammatory response.

关键词： Crohn’s disease enteral nutrition Body composition

Effect of early enteral combined with parenteral nutrition in patients undergoing pancreaticoduodenectomy

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World Journal of Gastroenterology 2013年第35期19卷 5889-5896页

作者： Xin-Hua Zhu Ya-Fu Wu Yu-Dong Qiu Chun-Ping Jiang Yi-Tao Ding Department of Hepatobiliary Surgery Affiliated Drum Tower Hospital Medical School of Nanjing University

AIM:To investigate the effect of early enteral nutrition(EEN)combined with parenteral nutritional support in patients undergoing pancreaticoduodenectomy(PD).METHODS:From January 2006,all patients were given EEN combined with parenteral nutrition(PN)(EEN/PN group,n=107),while patients prior to this date were given total parenteral nutrition(TPN)(TPN group,n=67).Venous blood samples were obtained for a nutrition-associated assessment and liver function tests on the day before surgery and 6 d after *** assessment of clinical outcome was based on postoperative ***-up for infectious and noninfectious complications was carried out for 30 d after hospital *** within 30 d afterdischarge was also ***:Compared with the TPN group,a significant decrease in prealbumin(PAB)(P=0.023)was seen in the EEN/PN *** bilirubin(TB),direct bilirubin(DB)and lactate dehydrogenase(LDH)were significantly decreased on day 6 in the EEN/PN group(P=0.006,0.004 and 0.032,respectively).The rate of gradeⅠcomplications,gradeⅡcomplications and the length of postoperative hospital stay in the EEN/PN group were significantly decreased(P=0.036,0.028and 0.021,respectively),and no hospital mortality was observed in our *** with the TPN group(58.2%),the rate of infectious complications in the EEN/PN group(39.3%)was significantly decreased(P=0.042).Eleven cases of delayed gastric emptying were noted in the TPN group,and 6 cases in the EEN/PN *** rate of delayed gastric emptying and hyperglycemia was significantly reduced in the EEN/PN group(P=0.031 and P=0.040,respectively).CONCLUSION:Early enteral combined with PN can greatly improve liver function,reduce infectious complications and delayed gastric emptying,and shorten postoperative hospital stay in patients undergoing PD.

关键词： enteral nutrition Parenteral nutrition Pancreaticoduodenectomy Complications Metabolism

Impact of regular enteral feeding via jejunostomy during neo-adjuvant chemotherapy on body composition in patients with oesophageal cancer

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World Journal of Gastrointestinal Oncology 2019年第12期11卷 1182-1192页

作者： Imran M Mohamed John Whiting Benjamin HL Tan Department of Upper Gastrointestinal Surgery Queen Elizabeth Hospital

BACKGROUND Malnourishment and sarcopenia are well documented phenomena in oesophageal *** undergoing neo-adjuvant chemotherapy prior to oesophagectomy have complex nutritional *** To examine the effect of regular nutritional support via feeding jejunostomy on overall body composition in patients undergoing neo-adjuvant chemotherapy prior to oesophagectomy for oesophageal *** Retrospective data were collected for 15 patients before and after neo-adjuvant *** patients had feeding jejunostomies inserted at staging laparoscopy prior to neo-adjuvant chemotherapy and underwent regular jejunostomy *** in body composition were determined by analysis of computed tomography *** Patient age was 61.3±12.8 years,and 73%of patients were *** time between start of chemotherapy and surgery was 107±21.6 *** was no change in weight(74.5±14.1 kg to 74.8±13.1 kg)and body mass index(26.0±3.8 kg/m^2 to 26.1±3.4 kg/m^2).Body composition analysis revealed a statistically significant decrease in lumbar skeletal muscle index despite regular feeding(45.8±8.0 cm^2/m^2 to 43.5±7.3 cm^2/m^2;P=0.045).The proportion of sarcopenic patients increased(33.3% to 60%).Six patients(40%)experienced dose-limiting toxicity during *** Regular jejunostomy feeding during neo-adjuvant chemotherapy can maintain weight and adipose *** alone is not sufficient to maintain muscle *** insight into the underlying processes causing reduced muscle mass in cancer patients may help to provide targeted interventions.

关键词： Body composition Neo-adjuvant therapy Oesophageal cancer enteral feeding

Effects of early enteral nutrition on immune function of severe acute pancreatitis patients

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World Journal of Gastroenterology 2013年第6期19卷 917-922页

作者： Jia-Kui Sun Xin-Wei Mu Wei-Qin Li Zhi-Hui Tong Jing Li Shu-Yun Zheng Department of Intensive Care Unit Nanjing First HospitalNanjing Medical University Department of General Surgery Jinling HospitalNanjing University School of Medicine

AIM:To investigate the effects of early enteral nutrition (EEN) on the immune function and clinical outcome of patients with severe acute pancreatitis (SAP).METHODS:Patients were randomly allocated to receive EEN or delayed enteral nutrition (DEN).enteral nutrition was started within 48 h after admission in EEN group,whereas from the 8 th day in DEN *** the immunologic parameters and C-reactive protein (CRP) levels were collected on days 1,3,7 and 14 after *** clinical outcome variables were also ***:Sixty SAP patients were enrolled to this *** CD4+ T-lymphocyte percentage,CD4+/CD8+ ratio,and the CRP levels in EEN group became significantly lower than in DEN group from the 7 th day after *** contrast,the immunoglobulin G(IgG) levels and human leukocyte antigen-DR expression in EEN group became significantly higher than in DEN group from the 7 th day after *** difference of CD8+ T-lymphocyte percentage,IgM and IgA levels was found between the two *** incidences of multiple organ dysfunction syndrome,systemic inflammatory response syndrome,and pancreatic infection as well as the duration of intensive care unit stay were significantly lower in EEN group than in DEN ***,there was no difference of hospital mortality between the two ***:EEN moderates the excessive immune response during the early stage of SAP without leading to subsequent *** can improve the clinical outcome,but not decrease the hospital mortality of SAP patients.

关键词： Early enteral nutrition Immune Severe acute pancreatitis

Early enteral Combined with Parenteral Nutrition Treatment for Severe Traumatic Brain Injury:Effects on Immune Function,Nutritional Status and Outcomes

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Chinese Medical Sciences Journal 2016年第4期31卷 213-220页

作者： Ming-chao Fan Qiao-ling Wang Wei Fang Yun-xia Jiang Lian-di Li Peng Sun Zhi-hong Wang Department of Neurological Intensive Care Unit the Affiliated Hospital of Qingdao UniversityQingdaoShandong 266003China Community Medical Service Center of Shuiqinggou Street QingdaoShandong 266042China Nursing School Medical College of Qingdao UniversityQingdaoShandong 266003China Department of Neurosurgery the Affiliated Hospital of Qingdao UniversityQingdaoShandong 266003China Department of Geriatric Medicine the Affiliated Hospital of Qingdao UniversityQingdaoShandong 266003China

Objective To compare the conjoint effect of enteral nutrition (EN) and parenteral nutrition (PN)with single EN or PN on immune function, nutritional status, complications and clinical outcomes of patientswith severe traumatic brain injury (STBI).Methods A prospective randomized control trial was carried out from January 2009 to May 2012 inNeurological Intensive Care Unit (NICU). Patients of STBI who met the enrolment criteria (Glasgow ComaScale score 6~8; Nutritional Risk Screening ≥3) were randomly divided into 3 groups and were administratedEN, PN or EN＋PN treatments respectively. The indexes of nutritional status, immune function,complications and clinical outcomes were examined and compared statistically.

关键词： enteral nutrition parenteral nutrition severe traumatic brain injury immune function complication